Pennsylvania Dental Jou rnal · 2010. 4. 19. · your average dental patient. She needed a filling but didn’t have dental insurance. She lived in northern New Jersey and found every

19

32

35

Evaluating Children’s Accessto Dental Services

Harrisburg Smiles

Building Alliancesfor Better Oral Health

PennsylvaniaDental Journal

Vol. 77, No. 5 • September/October 2010


Vol. 77, No. 5 • September/October 2010

THAYER DENTAL LABORATORY, INC.131 Old Schoolhouse Lane • P.O. Box 1204Mechanicsburg, PA 17055

717-697-6324 • 800-382-1240 • fax: 717-697-1412

www.thayerdental.com

... that’s asmart move.

“ Y o u r P a r t n e r i n M a s t e r i n g N e w T e c h n o l o g i e s ” ®

T H A Y E R D E N T A L L A B O R A T O R Y , I N C .

Thayer’s discount policydoesn’t rely on couponsor gimmicks . . .

Thayer Dental Laboratory has offered the same volume discount to its customers for over 30 years. We don’t offer specialcoupons to anyone - and we only have one price list for all our customers. Our discount policy treats everyone fairly.

Pay your statement balance by the 10th of the month:

For balances of $5,000 or more take10% off your statement balance if youpay by check - or 8% by credit card.

For balances of $2,500 to $4,999 take5% off your statement balance if you pay by check - or 3% by credit card.

For balances of $250 to $2,499 take 2% off your statement balance if you pay by check.

It’s just that simple.

September/October 2010 • Pennsylvania Dental Journal2

P e n n s y l v a n i a D e n t a l J o u r n a l • www. p a d e n t a l . o r g

Dr. Bruce R. Terry (Editor)85 Old Eagle School Road, Wayne, 19087-2524(610) 995-0109 • [email protected]

Dr. Joseph J. Kohler III (Associate Editor)219 W. 7th Street, Erie, 16501-1601(814) 452-4838 • [email protected]

Dr. Brian Mark Schwab (Associate Editor)1021 Lily Lane, Reading, 19560-9535(610) 926-1233 • [email protected]

Rob Pugliese (Director of Communications)P.O. Box 3341, Harrisburg, 17105(800) 223-0016 • FAX (717) [email protected]

Dr. Richard Galeone (Editor Emeritus) 3501 North Front Street, Harrisburg, 17110(717) 234-5941 • FAX (717) [email protected]

Dr. Judith McFadden (Editor Emerita)3386 Memphis Street, Philadelphia, 19134(215) 739-3100

Officers

Dr. William T. Spruill (President) �520 South Pitt Street, Carlisle, 17013-3820(717) 245-0061 • [email protected]

Dr. Dennis J. Charlton (President-Elect) ��P.O. Box 487 • Sandy Lake, 16145-0487(724) 376-7161 • [email protected]

Dr. Andrew J. Kwasny (Immediate Past President)3219 Peach Street • Erie, 16508-2735(814) 455-2158 • [email protected]

Dr. Gary S. Davis (Vice President) �420 East Orange St. • Shippensburg, 17257-2140(717) 532-4513 • [email protected]

Dr. Peter P. Korch III (Speaker) ��

4200 Crawford Ave., NorCam Bldg. 3P.O. Box 1388, Northern Cambria, 15714-1388(814) 948-9650 • [email protected]

Dr. Jeffrey B. Sameroff (Secretary) ��800 Heritage Dr., Ste 811 • Pottstown, 19464-9220(610) 326-3610 • [email protected]

Dr. R. Donald Hoffman (Treasurer) ��105 Penhurst Drive, Pittsburgh, 15235(412) 648-1915 • [email protected]

Trustees By District

1st...Dr. Thomas P. Nordone…2013 �207 N. Broad Street, Philadelphia, 19107-1500(215) 557-0557 • [email protected]

2nd...Dr. Bernard P. Dishler...2011 �Yorktowne Dental Group Ltd.8118 Old York Road Ste A, Elkins Park, 19027-1499(215) 635-6900 • [email protected]

3rd...Dr. D. Scott Aldinger...2012 ��8555 Interchange Road, Lehighton, 18235-5611(610) 681-6262 • [email protected]

4th...Dr. Michael S. Shuman…2013 �1052 Park Road, Blandon, 19510-9563(610) 916-1233 • [email protected]

5th...Dr. David R. Larson…2013 �1305 Middletown Rd. Ste 2Hummelstown, 17036-8825(717) 566-9797 • [email protected]

6th...Dr. John P. Grove...2011PO Box 508, Jersey Shore, 17740-0508(570) 398-2270 • [email protected]

7th...Dr. Wade I. Newman...2014Bellefonte Family Dentistry115 S. School St., Bellefonte, 16823-2322(814) 355-1587 • [email protected]

8th...Dr. William J. Weaver...2011 �Brookville Dental, 123 Main StreetBrookville, 15825-1212(814) 849-2652 • [email protected]

9th...Dr. William G. Glecos...20123408 State Street, Erie, 16508-2832(814) [email protected]

10th...Dr. Donald A. Stoner...2011 ��

Oakmont Dental Associates154 Allegheny River Blvd., Oakmont, 15139-1801(412) 828-7750 • [email protected]

ADA Third District Trustee

Dr. Charles R. Weber606 East Marshall Street, Ste 103West Chester, PA 19380-4485(610) 436-5161 • [email protected]

PDA Committee Chairs

Communications & Public Relations CommitteeDr. David A. Tecosky

Dental Benefits CommitteeDr. Tad S. Glossner

Government Relations CommitteeDr. Herbert L. Ray, Jr.

Membership CommitteeDr. Karin D. Brian

Access to Care CommitteeDr. Joseph R. Greenberg

Annual Awards CommitteeDr. Craig Eisenhart

Concerned Colleague CommitteeDr. Bartley J. Morrow

Environmental Issues CommitteeDr. Marian S. Wolford

Forensic Odontology CommitteeDr. Jeff D. Aronsohn

New Dentist CommitteeDr. Brian Mark Schwab

The Official Publication of the Pennsylvania Dental AssociationSeptember/October 2010 • Volume 77, Number 5

PENNSYLVANIA DENTAL JOURNAL (ISSN 0031-4439), owned and published by the Pennsylvania Dental Association, 3501North Front Street, Harrisburg, 17110, is published bi-monthly: Jan/Feb, Mar/Apr, May/June, July/Aug, Sept/Oct, Nov/Dec. Addressadvertising and subscription queries to 3501 North Front Street, P.O. Box 3341, Harrisburg, 17105. Domestic subscriptions areavailable to persons not eligible for membership at $36/year; International subscriptions available at $75/year. Single copies $10.Periodical postage paid at Harrisburg, PA. “The Pennsylvania Dental Association, although formally accepting and publishing reportsof the various standing committees and essays read before the Association (and its components), holds itself not responsible foropinions, theories, and criticisms therein contained, except when adopted or sanctioned by special resolutions.” The Associationassumes no responsibility for any program content of lectures in continuing education programs advertised in this magazine. TheAssociation reserves the right to refuse any advertisement for any reason. Copyright ©2010, Pennsylvania Dental Association.

POSTMASTER: Send address changes to Pennsylvania Dental Association, P.O. Box 3341, Harrisburg, PA 17105.

MEMBER: American Association of Dental Editors

Features19 Pennsylvania Medical Assistance:

Evaluation of Children’s Access to Dental Servicesby Monica Costlow, JD and Dr. Judith Lave

26 A Survey of Senior Dental Students’ Experienceswith Young Dental Patients in Pennsylvaniaby Rochelle G. Lindemeyer, DMD

32 Building Alliances for BetterOral Healthby Paul R. Westerberg, DDS

35 Harrisburg Smilesby Rob Pugliese, Director of Communications

Departments5 Impressions7 Letter to the Editor9 Government Relations13 Membership Matters17 It’s Your Money41 In Memoriam45 Cyber Salon47 Awards & Achievements49 Insurance Connection51 Continuing Education55 Classified Advertisements

The mission of the Pennsylvania Dental Journal is to serve PDA membersby providing information about topics and issues that affect dentists practicingin Pennsylvania. The Journal also will report membership-related activities ofthe leadership of the association, proceedings of the House of Delegates at theannual session and status of PDA programs.

3September/October 2010 • Pennsylvania Dental Journal


PDA Central Office

3501 North Front StreetP.O. Box 3341, Harrisburg, 17105(800) 223-0016 • (717) 234-5941FAX (717) 232-7169

Camille Kostelac-Cherry, Esq. Chief Executive [email protected]

Mary Donlin Director of [email protected]

Marisa SwarneyDirector of Government [email protected]

Rob PuglieseDirector of [email protected]

Rebecca Von NiedaDirector of Meetings and [email protected]

Leo [email protected]

Board Committees Legend

� Executive Committee �� Chairman

� Budget, Finance & Property �� Chairman

� Bylaws Committee �� Chairman

EDITORIAL BoardDr. Daniel Boston

Dr. Allen Fielding

Dr. Marjorie Jeffcoat

Dr. Kenneth G. Miller

Dr. Andres Pinto

Dr. Deborah Studen-Pavlovich

Dr. James A. Wallace

Dr. Charles R. Weber

Dr. Gerald S. Weintraub

September/October 2010 • Pennsylvania Dental Journal4

Are You My Dentist?Jane Smith (name and details

modified to protect her identity) wasyour average dental patient. Sheneeded a filling but didn’t have dentalinsurance. She lived in northern NewJersey and found every dentist to betoo expensive. She had a friend tellher about Dr. Maria Mendel (her realname). Her friend told her thatDr. Mendel worked out of her apart-ment and was very cheap.

So, Jane made an appointment andwent to see Dr. Mendel. The officedidn’t look like any other office shehad been to before. It looked morelike someone’s living room. After anoral exam, Jane was told that sheneeded a few fillings. No radiographswere taken and Dr. Mendel said thatno local anesthetic was needed sincethe cavities were not very deep.Dr. Mendel didn’t use a drill. She saidthe cavity was soft and just need tobe scooped out with a dental instru-ment. The fillings were pretty easy todo and Jane thought she had foundherself a new dentist.

A few weeks later one tooth beganto hurt. She went back to Dr. Mendeland was told that everything was fine.She went back a few more times andfelt that Dr. Mendel didn’t want tosee her any longer. Because her toothcontinued to hurt, she went to anotherdentist who took a radiograph andperformed an examination. He thoughtsomething looked strange and calledDr. Mendel.

Bill Jones (name and details alsochanged) had heard about a dentistnear his apartment in the Atlantasuburb of Roswell, Ga., namedDr. Ardilla-Ramirez (real name). Billalso was looking for affordable dentalcare. He had lost his job a year earlier

and had no money or benefits fordental care. He had a badly decayedtooth and wanted an extraction.Dr. Ardilla-Ramirez seemed professionalwith her lab coat on. Her office had aTV style lounge chair rather than astandard dental chair. Bill thought itwas odd, but it was really comfortable.Dr. Ardilla-Ramirez didn’t acceptinsurance or credit cards. She onlytook cash. She had three others wait-ing on a sofa in the same room whileshe extracted Bill’s tooth. A weeklater, with an infection, Bill returned tothe dentist, but the dentist told himeverything was fine. Bill eventuallywent to an oral surgeon who foundhalf of the roots remaining, and whenhe asked who the dentist was thatdid the extraction, the surgeon wassurprised that he had never heard ofDr. Ardilla-Ramirez.

Dr. Tim Gurley (real name) practicedwith his father for nearly 10 years.He helped his dad as he eased intoretirement mode. New patients and

some current patients of his father’sbecame Tim’s patients. He performedextractions, restored implants andmade dentures.

They were all living the Americandream. Hardworking, dedicatedpractitioners, seeing patients every day.They practiced general dentistry andhad many patients. Maria Mendel, 47,from Bound Brook N.J., Martha GabiArdilla-Ramirez, 49, of Roswell Ga.,and Tim Gurley, 40, of Tampa, Fla.Maria practiced out of her home innorthern New Jersey. Martha alsoprac-ticed out of her home in the Atlantasuburb of Roswell. Tim practicedin the Tampa office of his fatherDr. Max Gurley.

While each practice was different,they all shared one very importantattribute.

Maria and Martha had each prac-ticed for less than one year while Timhad practiced for nearly 10 years.What was the one thing they all hadin common? They were all found tobe practicing dentistry without alicense! Their respective State Boardscaught each of them after numerouscomplaints were filed. In each case,patients went to a new dentist witha common complaint of poor dentalwork. When the new dentistquestioned the work of the previousdentist, each found that the dentistrywas done by someone they didn’tknow.

Maria worked out of one roomwith a mix of questionable equipment.She was also in possession of narcoticmedication without a license to pre-scribe or dispense. Martha, originallyfrom Bogotá, Columbia, also practicedout of a room with a lounge chairrather than a standard dental chair

Impressions


D r . B r u c e R . T e r r y

(continued on page 6)

and used mostly hardware store styletools and a Dremel like tool ratherthan standard dental instruments.Tim had been extracting teeth, amongother procedures. Although he wasonly a dental assistant, he had beenpracticing dentistry under the super-vision of his father, Dr. Max Gurley.

None of these individuals went todental school abroad or in the UnitedStates. Maria and Martha hardly hada normal practice. Each worked inher apartment or a rented room. Theirpatients had to be aware that theyweren’t for real. Was it denial becauseof the affordability? I seriously doubtthat these two women accepted dentalinsurance, so it was a fee-for-servicebusiness. All dentists dream of a fee-for-service practice. These impostersfigured out how to get this covetedpatient population into their chairs,DentalEz and Barcalounger alike.

One of the biggest medical problemsfacing our society today is access todental care. The complexity of theproblem has all levels of organizeddentistry and government scramblingfor solutions. It also has dental patientsseeking care in unlikely places.Dentists volunteering their time havebeen one important solution. Eachyear, hundreds of thousands of hoursare donated around the world toprovide needed dental care to thoseless fortunate. From the far Asiancontinent to our neighborhoods,dentists, dental students and dentalhygienists proudly give their time andmaterials to help others.

Medicaid is another component tothe problem. The government reim-burses providers at levels so low thatit hardly pays to offer their services.With delay of claims and the numberof no-show patients, the dentalMedicaid system is seriously flawed.But, it continues to operate and

provide needed care to many patients.The dentists who stay in this systemare the real heroes.

Local nonprofit dental clinics alsohelp fill the dental care gap. Dentistseither volunteer to work in a clinic oragree to see patients in their ownoffices at no cost. This is a very gener-ous solution, but there are too manypatients and too few dentists. Moreimportantly, we are not going to solvethe access issue with charity alone.

Dental schools also help, but theyoperate as a business and do notgenerally offer free dental care. Theymust make money to cover their costs.In fact, most dental schools don’teven break even with the fees chargedin the dental clinic.

It’s time to stop blaming the lackof access to care on someone else andtime to start trying to help. Anyone

who is not for one solution or anothermust come up with an alternative,otherwise they are just part of theproblem. If we try something and itdoesn’t work, then we will have to trysomething else. It’s too easy to just say,“it’s complicated and can’t be solved.”I don’t want to see us mandated todo things. I would rather we continueto solve and promote what we do sowell, help others in need. Just do adaily search for the keyword “dental”under Google News and you will see atleast three news items each day aboutdentists helping in their community.That is the message we need to con-tinue to promote – dentists are part ofthe solution, not part of the problem.As far as unlicensed dentistry, it goesto show you that we are envied byothers and trusted by many.

—BRT

6 September/October 2010 • Pennsylvania Dental Journal

Impressions

Dear Dr. Terry:

In reviewing the Insurance Connectionin the May/June 2010 issue of thePennsylvania Dental Journal, it appearsto me that the more things change,the more they stay the same. Itabsolutely blows my mind to thinkthat fellow practitioners will sign anagreement which allows a third partycarrier to dictate the fees which theycan charge in their dental office fornon-covered services. But, that reportsays 85 percent of the participants inthe UCCI plan signed that contract.Are we really that ignorant, as lambsbeing led to the slaughter?

For years, the PDA committee thataddresses dental insurance issues,which has been known by numerouscommittee titles, in addition to theADA Council on Dental BenefitPrograms, has struggled to protectour inalienable right to charge feesthat we think are appropriate basedupon the technology, the time, thematerials and the difficulty of proce-dure. Each and every dental officemust decide for itself what fee isappropriate for each service that isprovided and this is as it should be.However, to acquiesce to the dentalinsurance industry telling us whatfees we can charge is appropriate todental socialism. The variouscommittees have struggled with thisissue because many of our colleagueswill readily agree to have a third-partycarrier dictate the fees that they chargefor specific services. Unfortunately,this puts those of us who refuse toparticipate in these plans at a distinctdisadvantage, as patients will con-stantly hassle us to reduce our fees orthey will leave our practice and go tothat of a “participant.”

In Pennsylvania, we are attemptingto have legislation passed which willprohibit insurance companies fromthe practice of dictating fees forservices that they do not cover. In thejournal article it states that UCCIdoes not have plans to change thispolicy unless the Pennsylvania GeneralAssembly passes legislation prohibitingthis insurance practice. The bottomline, my dear colleagues, is that wemust become proactive and contactour legislators on this important issue.

Rest assured that the coffers of UCCIand the other third parties are fundingour legislators’ PACs much more thanwe as individuals can do. However, ifwe continue to try and remain unifiedand support this legislative activity,just maybe, we may obtain success inthe passing of this important legislation.

But, on the other hand, apparently85 percent of the participants couldcare less whether or not the legislatureacts on this issue. We can only con-tinue to hope.

Sincerely, George A. Kirchner, DDS

Dear Editor:I enjoyed reading Dr. Mark Funt’s“It’s Your Money” piece on health carereform (July/August), since it’s alwaysstimulating to read a strong opinioneven when you don’t agree with it.I can appreciate Dr. Funt’s pro-freemarket, anti-big government philoso-phy, although the idea that govern-ment is the problem rather than thesolution would seem to have been aneasier sell back in the 1980s than in2010 (Halliburton? BP? Enron?Blackwater? Bernie Madoff?). But Iwas disappointed that Dr. Funt endedhis article by repeating a story that’s

been going around that Congressionalstaffers, who helped write the HealthCare Reform legislation, put in aloophole exempting themselves fromthe new law. On the face of it, theimplication is that these liberal policywonks, who, despite having devotedyears writing and rewriting a nationalhealth care bill, in their heart of heartsknow the bill isn't any good, and sothey surreptitiously hid a clause deepin the bowels of the bill to exemptthemselves, and only themselves. Sortof a DaVinci Code scenario. But alas,as with so many sources of right-wingoutrage sailing through the Internetand over the radio waves, there ismuch less fire here than smoke. Anonpartisan website, FactCheck.org,explains that all members of Congressand their staffs are covered by thenew health care bill. The exemptionissue came up because of some overlyspecific wording in a Republicanamendment to the bill, regarding whichgovernment employees would berequired to buy their insurance throughthe new state exchanges. Both partiesrealize the need to correct the wording.There is no hidden agenda. Passingon a half-truth like this is not harmless.Our nation has been paralyzed bydistrust of government, and more andmore politicians are elected not toimprove government, but to dismantleit. You may believe, as I do, that thehealth care law is a brave, ifincomplete, attempt to right seriousinjustices in our health care system,or you may believe that the wholething is a huge boondoggle, but inmaking our point, let’s not fan theflames of anti-government paranoia.

Jay Cohen, DMD

Letters to the Editor



Editor’s Note: Following isDr. Funt’s response to some ofDr. Cohen’s assertions.

Dear Jay:

I agree with your comments on theEnrons of the world, and I addressedthat issue in my article. You will beglad to know that I do not believe therecently passed financial regulationbill went far enough in solving suchproblems, especially in regards to the“too big to fail” concept. I visited theFactCheck website, which is from theAnnenberg Public Policy Center outof the University of Pennsylvania.The most recent article on the reformbill that I could find was “MoreMalarkey About Health Care” datedApril 19, 2010. The article doesconclude “that some Capitol Hill staffworkers may still continue to getcoverage the same way they alwayshave,” meaning they will not be subjectto the new health care bill. I guessthe details still need to be workedout. Finally, I am not anti-governmentand we could debate what rolegovernment should play in the privatesector, but the crux of the article wasmy opinion on how I feel the newhealth care law will continue to addto our deficit and how that deficit willaffect the economy in general andinvestors in particular. Only time willtell which one of your two scenarioswill play out regarding the health carebill.

I appreciate your comments. It is ourability to disagree and discuss ourdifferences that makes America great.

Mark


Letters to the Editor

Government Relations


Pennsylvania General AssemblyThe Pennsylvania General Assemblyreturned to Harrisburg in mid-September as PDA geared up forelection season and the end of thelegislative session.

Many of our legislative initiativesremained undone when the GeneralAssembly adjourned for the summer.Our first priority is to pass SB 1222before the session ends in November.This bill would prohibit all insurancecompanies from capping fees onservices they do not cover under theirplans. We know this is an issue thatresonates with many members whoparticipate with insurance plans.

PDA continues to monitor and respondto a number of other legislative issues,advocating for the profession and yourpatients on issues such as assigningbenefits to non-participating providers,limiting insurers’ ability to retroactivelydeny claims, the use of dentalamalgam, health care practitioner loanforgiveness and policymakers’ call toassess the ability for the underservedand special needs patients to accessdental care.

We cannot accomplish theselegislative goals without your help.Please take a few minutes to respondto the CapWiz action alerts PDAsends periodically to those memberswith email addresses, or sign uptoday to serve as a grassroots contactdentist for your representative andsenator. Stay tuned for informationabout the 2011 Day on the Hill,which is slated for June 14. You’llfind a registration form in theNovember/December issue of theJournal. All members, spouses anddental students are encouraged toattend.

Below are insights on some of theissues that PDA will address before theend of the year. Legislation that doesnot pass will need to be reintroducednext year.

• SB 1222, prohibiting insurers fromcapping non-covered services:PDA is working hard to correct anunfair insurance practice that allowsinsurers to cap those services notcovered under their dental plans.This policy will significantly impactyour business operation and patients.SB 1222, introduced on PDA’s behalfby Sen. Kim Ward (R-Westmoreland),was a primary focus for attendeesduring Day on the Hill on June 8.Those who attended were instrumen-tal in having SB 1222 pass out ofthe Senate Banking and InsuranceCommittee that same day. PDA isworking to educate all senators aboutthe need to pass this legislation.Please refer to the August editionof Transitions to find out how youcan help pass this bill.

• HB 1049, insurance coveragefor general anesthesia when neededfor dental treatment for childrenseven years of age and younger andspecial needs patients: HB 1049would allow dentists to use theirclinical judgment whether certainchildren under the age of sevenneed general anesthesia so they canprovide quality dental care. The billalso would extend coverage to anyspecial needs patient of any age.While it is difficult to pass insur-ance mandates, we are encouragedthat this bill has the momentum topass the House of Representatives.Having been approved by the HouseInsurance Committee in October2009, PDA began focusing its energy

on convincing members of theHouse Appropriations Committee toconsider the bill. HB 1049 has notmoved from this committee.

• HB 2509, Assignment of Benefits:This legislation would requireinsurers to assign benefits to thoseproviders who are not participatingproviders in their patients’ insuranceplans. Rep. Thomas Murt(R-Montgomery) introduced HB2509 on PDA’s behalf and it is nowbefore the House InsuranceCommittee for consideration.Though it is unlikely this legislationwill pass either chamber before theend of session, PDA is now educat-ing lawmakers about this issue,with the intent of reintroducing thebill next session.

State Board of DentistryThe State Board of Dentistry (SBOD)is working on a number of issuesimpacting the profession, includingwho has the ability to administerBotox and teeth whitening material.The SBOD is also finalizing its plansfor how to implement the newlegislation that passed expanding thescope of practice for expanded func-tion dental assistants (EFDAs).

Allowing EFDAs to perform expand-ed duties allowed under Act 19

At its July meeting, the SBOD passedproposed rulemaking that wouldrequire all grandfathered EFDAs tocomplete three hours of continuingeducation on those duties nowallowed by law, specifically coronalpolishing. The three-hour requirementis part of the 10 hours currentlyrequired. Those EFDAs who will be




certified for the 2011-12 biennialperiod would also have to obtain threehours of continuing education. AllEFDA programs will integrate trainingfor these expanded functions intotheir existing curriculums. These reg-ulations are not yet final, but shouldbe in 2011.

Regulating Teeth Whitening as thePractice of Dentistry

Due to growing concerns about thepreponderance of non-dentalprofessionals offering teeth whiteningservices to the public, the SBODdrafted a policy statement that wouldeffectively regulate teeth whiteningservices as the practice of dentistry, tobe administered by dental profession-als only.

The SBOD’s draft policy statementstates that tooth whitening may beperformed by a licensed dentist, orother qualified dental staff (underdentists’ direct supervision). Toothwhitening is defined as any means ormethods used to whiten or bleachteeth, or the dispensing of a tooth-whitening agent to another person.There is an exemption for thoseproducts that consumers can purchaseover-the-counter. This policy is stillin draft form and must be approvedby offices in the Governor’sAdministration before it becomes final.However, due to a pending lawsuitagainst the North Carolina Board ofDentistry regarding its policy restrictingtooth whitening as the practice ofdentistry, the SBOD is postponingimplementation of its policy statementuntil the lawsuit is settled.

Regulating the Administration ofBotox and Dermal Fillers

The SBOD drafted a policy statementstating that it considers it the practiceof dentistry when Botox productsand dermal fillers are administered tothe structures associated with thehuman teeth or jaws, or associatedstructures. If passed, this policystatement will provide more guidanceto licensees and the public aboutwhat is acceptable in the dental office.Dentists who choose to perform thisservice must be properly trained andobtain informed consent from patients.Stay turned for more informationonce this policy statement is approvedand enacted.

PDA recognizes new dentists and dental students as the futureof dentistry in Pennsylvania and wants to foster and encouragetheir participation in the organized dentistry community.

Please show your support for new dentists, dental studentsand the future of organized dentistry by agreeing to be a men-tor.

Visit www.padental.org/mentoring to register as a mentor.

Become a

Mentor


A Call To ActionAs John Adams once said, “Always votefor principle, though you may votealone, and you may cherish the sweetestreflection that your vote is never lost.”

With the 2010 statewide electionsjust around the corner, it is imperativethat grassroots lobbying and volunteerefforts be kicked into full swing. PDAchallenges our members to live up to theaforementioned quote of John Adamsand cherish the fact that your vote as adentist means something, even if othersmay disagree. The time and effort you,as members, put into November’selection will produce a profound resulton future legislation. Whether it iscontributing money to PADPAC,writing to your state elected officialsor congressmen, or putting a candi-date’s sign in your front yard, manylegislators will feel your influence andappreciate your involvement.

When deciding whether to participate,remember the battles of those legislatorsup for re-election and their push topass legislation for you. Remember inparticular Sen. Jane Orie and Rep. EddieDay Pashinski and their dedicationto the dental profession by sponsoringand helping pass HB 602, the EFDAscope of practice legislation, and thoselegislators who proudly voted in favorof its passage. Without the aspirationsand the drive of these individuals,this bill would still be in limbo in theGeneral Assembly. PDA encourages youto take the time to contact Sen. Orieand Rep. Pashinski especially, and

thank them for their commitment tothe profession.

And think about your PADPAC’sachievements and the daunting chal-lenge of finding new ways to interactand voice your concerns to legislators.The importance of PADPAC shouldnot go unmentioned; by continuouslydonating to PADPAC you are investingin the future. You are investing inthose noble men and women whoserve our state proudly and who areeveryday fighting for the interests ofthe dental profession. We want you torecognize the advantages of thisinvestment, and challenge you to takea leap of faith and show your support.Legislators want to hear from you,and the more you get out and speakdirectly to them, the more likely legis-lators will hear your call.

As George Washington once said,“Associate yourself with men of goodquality if you esteem your ownreputation; for ‘tis better to be alonethan in bad company. Speak no evil ofthe absent, for it is unjust. Undertakenot what you cannot perform, butbe careful to keep your promise. Thereis but one straight course, and that isto seek truth, and pursue it steadily.Nothing but harmony, honesty, indus-try and frugality are necessary to makeus a great and happy nation.”

George Washington recognized theimportance of banding together as aninfant nation struggled to perseverethrough the almost impossible chal-lenges. PDA recognizes the challenges

we face everyday, and like Washington,we too can and will stick togetherand stay the course to write our ownhistory. Invest in PDA, and we willsurely make it worth your while.Together, we can accomplish anything.

Remember, the more member dentistsspeak up and contact legislators, themore we are combating oppositionfrom insurance companies and otherlobbies who are working against us.PDA and PADPAC are here to help youin this time of need, and no matterwhat the issue, we stand firmly behindyou. As a reminder, all House ofRepresentatives seats and one-third ofSenate seats are up for re-election onNovember 2. Reach out to yourrepresentatives and let them knowyou care and want to be heard. To findout who your representative is, pleasevisit http://www.legis.state.pa.us.

We remind you that we do not backa specific party, but only candidateswho fight for your issues and yourprofession. To further discuss ways tobecome involved in the electionprocess, donate to PADPAC or find outwhom your representatives are, pleasecontact Don Smith, government rela-tions coordinator, at [email protected]

or (800) 223-0016, ext. 108.

Don Smith is a new member of thegovernment relations team, and wouldbe happy to attend district or localdental society meetings to discussPADPAC or legislative issues. PDAencourages you to take advantage ofthis opportunity.


Membership Matters


A Checklist for Moving Your PracticeBy Tori Rineer, Membership Coordinator

Perhaps you’re looking to downsize, expand or relocate your practice to a new area. Let PDA assist with making yourmove as smooth and successful as possible with the “Moving Your Practice” Checklist.

Checklist for Moving Your Practice� Determine a budget for the move� Select new office location� Professional Notifications

� Landlord/Lease holder� Accountant� Financial Institution� Patients

� Display flyers in the office, discuss duringcheck-in or treatment, have staff give a reminder at check-out

� Have new appointment and business cards,stationary, address stamps and return mailing labels made with the new office address

� Send postcards announcing the move to all patients

� Include a message about the relocation in your “on-hold” messaging system or after-hours answering machine

� Pennsylvania State Board of Dentistry (SBOD)• You must notify the SBOD within 10 days of a

change of office address.• Contact information

Phone: (717) 783-7162Fax: (717) 787-7769E-mail: [email protected]: www.dos.state.pa.us/dent

� Drug Enforcement Administration (DEA) Office – Registration Change• Registration changes (change of address) should

not be submitted until an approved state license for the new address is received. Changes will become effective immediately upon DEA approval.

• Phone, DEA Call Center: (800) 882-9539Local DivisionsPhiladelphia:(215) 238-5160 Pittsburgh: (412) 777-1870Scranton: (570) 496-1020E-mail: [email protected]: www.deadiversion.usdoj.gov

� United States Postal Service: www.usps.com� Insurance providers� Electronic claims clearing house� Credit card companies� Professional Associations

• Pennsylvania Dental Association (800) 223-0016We will forward your change of address to ADAand your district/local dental society.

� Practice support providers:� Utility companies, municipal services� Practice software company� Website design company� Product supply companies� Answering service company� Patient payment/financing company

� Prepare the office� Inventory supplies� Disinfect instruments, countertops� Properly dispose of refuse, chemicals, sharps

� Network by attending local dental society meetings in new location

Additional items for consideration:� Place an advertisement in local newspapers� Send thoughtful expressions of appreciation (flowers,

thank you cards or other modest gifts) to businesses or referrals that helped to support your former office

� Thank your patients for staying with you and for coming to your new location

The following resources can be used to help determine anew location for your practice:

• Consider Pennsylvania! - Lists statistics for the numberof privately practicing dentists, population, number of patients per dentist, average age of practicing dentists and median household income, all broken down by county. Contact PDA’s Membership Department at (800) 223-0016 to request a copy or simply visit www.padental.org/am/pdf/considerpa.pdf.



Membership Matters

ADA Library Materials• Dental Office Design: A Guide to Building, Remodeling

and Relocating (2002)• ADA Demographic Reports (State and County) -

The reports are valuable for dentists who areestablishing their practices or for those planning to move. These reports also contain dentist profile including county-level estimates of the number of dentists, breakdown by primary occupation,specialty, age and sex, population profile of county level and benchmark data, current populationestimates and five-year projections. Reports also include suggestions for evaluating a new practice area. As State and County Demographic Reports are custom-produced, please state the name of the desired county(s) and state when ordering. Please note that these reports are produced on a per-countybasis; one report equals one county. ($75 per report)

• A Guide to Closing a Dental Practice (2008)

Supplemental ADA Materials• New Practice Checklist – provides a list of key

issues frequently confronted by dentists opening a new practice.

• Practice Management – Starting Your DentalPractice (Revised 2007)

• The Ultimate Dental PR Kit for Dentists and theDental Practice (2002)This guide will help dental professionals developpromotional and public relations campaigns for theirpractices and shape public opinion about theprofession of dentistry. It discusses planning a publicrelations campaign and provides examples of press releases, speeches, public service announcements and other promotional materials.

Many of these materials and more are available through theMembers’ Lending Library. All items found in the catalogare free to PDA members, who are charged only nominalshipping and handling fees. Visit www.padental.org/libraryto view the entire library catalog or to place an order.

Dr. Smriti BajajUniversity of PittsburghPittsburgh

Dr. Miriam BehpourUniversity of PittsburghPittsburgh

Dr. Brendan P. BernardUniversity of PittsburghMars

Dr. Nandhini BogavelliBoston UniversityHarrisburg

Dr. Holly J. BraninTemple UniversityYork

Dr. Amy L. CabeWest Virginia UniversityCanonsburg

Dr. Elsie M. CasimirTemple UniversityLower Gwynnedd

Dr. Jeremy R. CathermanUniversity of PennsylvaniaClearfield

Dr. Kavitha D. ChadhalavadaNew York UniversityCherry Hill, NJ

Dr. Hal L. CohenTemple UniversityPhiladelphia

Dr. William M. CrimUniversity of MarylandMifflintown

Dr. Sonal J. DaveUniversity of PennsylvaniaPhiladelphia

Dr. Kevin F. DyerNew York UniversityMechanicsburg

Dr. Mohammad B. ElkhatibUniversity of PennsylvaniaBlue Bell

Dr. Vincent P. FloryshakTemple UniversityChester Springs

Dr. Jeffrey M. GelbUniversity of PennsylvaniaBryn Mawr

Dr. Katarzyna I. GlabUniversity of PittsburghPittsburgh

Dr. Sai GuduruBoston UniversityHarrisburg

Dr. Kamal HaddadCase Western Reserve Univ.Bethlehem

Welcome New Members!Following is a listing of members who have recently joined PDA, along with the dental schools from which they graduatedand their hometowns.

Dr. William S. HeddaeusCase Western Reserve Univ.Penn Hills

Dr. Pieter H. HeemstraUniversity of PittsburghJefferson Hills

Dr. Jaime L. HorneWest Virginia UniversityThree Springs

Dr. Chinchai HsiaoUniversity of PennsylvaniaPhiladelphia

Dr. Tarik W. JbarahUniversity of PennsylvaniaReading

Dr. Aditi JindalUniversity of PittsburghPittsburgh

Dr. Brandon KangNew York UniversityWilkes Barre

Dr. Venkateswar R. KapaBoston UniversityHarrisburg

Dr. Steven Jae Doo KimUniversity of PennsylvaniaPhiladelphia

Dr. Joseph A. KobeskiTemple UniversityChadds Ford

Dr. Karessa KuntzUniversity of MichiganPittsburgh

Dr. Harold Ross LambertUniversity of PennsylvaniaNewtown Square

Dr. Michael E. LisienUniversity of PittsburghCoraopolis

Dr. Monali MaBoston UniversityPhiladelphia

Dr. Karl D. MaloneyNew York UniversityBasking Ridge, NJ

Dr. Richard C. MandelUniversity of PennsylvaniaSpringfield

Dr. Adam L. MartikUniversity of PittsburghPittsburgh

Dr. Brian S. MartinUniversity of PennsylvaniaBlawnox

Dr. Mary J. MassaroTemple UniversityMedia

Dr. John Paul MattaUniversity of PittsburghPoland

Dr. Jonise A. McDanielHoward UniversityHarrisburg

Dr. Amadee B. MerbedoneWest Virginia UniversityFairchance

Dr. Damian C. MililloTemple UniversityClifton Heights

Dr. Bryan D. MohneyUniversity of PennsylvaniaClearfield

Dr. Heidi L. MoosUniversity of PittsburghAlexandria, VA

Dr. Long Fnu MugiantoTemple UniversityRadnor

Dr. Adam W. MychakUniversity of PittsburghPittsburgh

Dr. Stephen J. OllockTemple UniversityMainesburg

Dr. Abhishek PanditUniversity of PennsylvaniaLancaster

Dr. Raj P. PatelTemple UniversityLanghorne

Dr. Matthew C. PooreUniversity of MarylandBinghamton

Dr. Christina R. Rabij-SchmelerSUNY BuffaloPittsburgh

Dr. Rick A. ReineckerTemple UniversityReinholds

Dr. Felipe RolaUniversity of PittsburghLansdale

Dr. Morgan S. RutledgeUniversity of LouisvilleGreensburg

Dr. Kristen V. SchollUniversity of PennsylvaniaArdmore

Dr. Eric C. SeidelTemple UniversityGettysburg

Dr. Maria B. SteedTemple UniversityCheltenham

Dr. Parveen SultanaUniversity of PennsylvaniaPhiladelphia

Dr. Alan J. TengonciangTemple UniversityPhiladelphia

Dr. Krishna C. ThumatiBoston UniversityHarrisburg

Dr. Loris J. TinianowBryn Mawr

Dr. Jacquline TomeUniversity of PennsylvaniaBreinigsville

Dr. Joshua TranTemple UniversityTower City

Dr. Daniel S. VanVolkenburghNorthwestern Collegeof Dental SurgeryCalifon

Dr. William J. VincentTemple UniversityEast Petersburg

Dr. Timothy A. WeibleySUNY BuffaloLemoyne

Dr. Lawrence WongTemple UniversityPhiladelphia

Dr. Jie YangMaple Glen

Dr. Qing YangUniversity of PennsylvaniaPhiladelphia

Dr. Thadeus G. ZawislakTemple UniversityOil City

Membership Matters


Fixed Income Investing(Part 1)By Mark J. Funt DMD, MBA

So far in this series, I have generallywritten about investing in equities(stocks). In this piece, I am going tobegin the discussion on fixed incomeinvesting. Fixed income runs thegamut from risk free, very short-termsavings/money market accounts, tovery risky long-term bond investingand everything in between.

The bond market, a very large partof the fixed income market, is a marketno different than the stock market.Prices on bonds, like stocks, fluctuateon an intra and inter day basis. As amatter of fact, some people buy bondslike they do stocks, in hopes ofcapturing capital appreciation as wellas a fixed rate of return. Bonds comein all shapes and sizes. There areultra-short, short, intermediate andlong-term bonds. There are zerocoupon, savings and Build AmericaBonds. There are low, medium andhigh quality bonds, taxable and taxfree bonds, very safe and very riskybonds as well as low and high yieldingbonds. Just like stocks, the bigger therisk you take in bond investing, thegreater the potential return. The yieldon bonds is generally based on thepast and present interest rates, theyear of maturity as well as the creditquality of the issuer of the bond. Bondscan be bought at par, at a premiumor a discount, the details of which willbe explained in a future article.

In order to be a serious bondinvestor, you need to have someunderstanding of the economy andhow fiscal and monetary policy affectsthe economy, as well as how theeconomy affects interest rates. Asalways, I will try to explain these factors

in an over-simplified manner. Thefirst thing you need to know is thatthe economy goes through naturalcycles of booms and busts. There areperiods of economic growth andeconomic slowdowns that can lead torecessions and even depressions.

After 6-7 years of economic growth,the economy slipped into a recession,which is defined as two consecutivequarters of negative GDP (GrossDomestic Product). Due to a series ofseveral very unfortunate economicmishaps, which I have written aboutin previous articles, this recession ismuch worse than previous ones. Inmany cases, the strength of the eco-nomic expansions and severity of theeconomic downturns has to do withhow well the economy is managedby the federal government. The truthof the matter is that the Presidentof the United States has very littlecontrol over the success and failureof the economy, although he will getthe blame when the economy is failingand the credit when it is strong. Thepresident, with approval of Congress,can only do two things in controllingfiscal policy — increase or decreasegovernmental spending and/orincrease or decrease taxes. The Bushadministration opted to lower taxeswhereas the Obama administrationopted to increase government spending.

Some would question whetherspending money the government doesnot have is a good idea to try to getus out of a recession, but time will tellwho is and isn’t correct. The muchmore powerful branch of the govern-ment is the Federal Reserve Board, thebody that controls monetary policy.Although the Federal Reserve Chairmanis appointed by the President andapproved by the Congress, at this pointthe Federal Reserve is completely

independent and autonomous fromthe executive and legislative branchesof the government. The FederalReserve has many tools at its disposalon how to accomplish its goals ofkeeping the economy growing at ahealthy pace and keeping inflationlow, a daunting task to say the least.

The most powerful tool the Fed hasis to lower or raise interest rates. TheFed tries to stay ahead of the curveand be proactive with its monetarypolicy. However, like the stock market,the Fed often goes too far, too fast ortoo slow in accomplishing its goals,causing bubbles in the economy. As Ipreviously stated, besides promotingeconomic growth, the Fed is veryconcerned about controlling inflation.Inflation is simply defined as toomany dollars chasing too few goods.This is a simple supply and demandequation. If lots of people have lots ofmoney to spend, businesses willincrease the price of their goods andservices.

A perfect example is the recenthousing bubble. As the Fed loweredinterest rates, more and more peoplecould get loans as money becamemore available and the prices of homes“literally” went through the roof.Of course, one of the causes of ourpresent economic tsunami is that thebanks gave loans to people whocould never afford to pay them back.Many people blame Alan Greenspan(the former Fed chairman) for lower-ing rates too low too fast, creating thehousing bubble. However, as bad asinflation is, the Fed is much moreconcerned about deflation. Deflationis defined as a decrease in prices.Deflation is more destructive to theeconomy then inflation. If businesseshave to lower prices, this will cut intotheir profits and may mean layoffs

It’s Your Money


It’s Your Money


or even shutting their doors. It isactually better for the economy whena business has pricing power asopposed to no pricing power. Again,look at home prices. The deflation inprices has caused a lot of people tosee the value of their homes declinedramatically. In some cases, the pricesdropped so low, their mortgage wasworth more than their home andthey just walked away (foreclosed) ontheir home. This negative wealtheffect not only makes people feelpoorer but also takes away the abilityfor them to borrow from their home,which many people did as a sourceof funds for many of their largerpurchases, not to mention what it didto the construction industry.

The Fed, like the stock market,looks at a myriad of economic reportsto determine what decision it willmake regarding the lowering or raisingof interest rates in order to strike thatbalance between fostering economicgrowth and stable inflation. Theseindicators include but are not limitedto GDP, housing starts, durable goodsorders, consumer and producer priceindices and the unemployment report.All of these stats are readily availableto anyone who wants to ascertain them.

The Fed can only control veryshort-term interest rates and the mar-ket and market forces will determinelong-term interest rates. In manycases, the bond market will bid uplonger term interest rates in anticipa-tion of the Fed increasing short-termrates or lower rates if the marketfeels the Fed will be cutting interestrates. In some cases, if the bond mar-ket feels the Federal Reserve is aheadof the curve when it increases short-term interest rates, longer term bondsinterest rates will actually decrease.Although this may seem contradictoryto what I have written, this phenome-non is referred to as a bear flattening;because the market believes the tight-

ening of monetary policy will keepinflation in check even if this meansa slowing of the economy, which willeventually lead to a lowering of inter-est rates. I know it gets confusing.Bond prices respond directly to theseinterest rate changes. There is aninverse relationship between interestrates and the prices of bonds. Asinterest rates increase, bond pricesdecrease and as interest rates decrease,bond prices will increase. Remember,just like stocks, bond prices arechanging all the time. Of course, thereare other factors that can affect theprices of bonds as well. However,you cannot be a serious bond investorwithout understanding interest ratesand having some idea as to whichdirection interest rates are headed.

For example, if you think interestrates are going up, you may want to

buy short-term bonds so you cantake advantage of buying longer termbonds when interest rates increase.On the other hand, if you think inter-est rates are going down, you maywant to not only lock in higher inter-est rates with longer term bonds, butalso take advantage of capital appreci-ation of your bond as rates decline.

You are probably wondering howyou know which way interest rates aregoing. First of all, as I write thisarticle, interest rates are at a historicallow and can only go up because theyjust cannot go any lower. Secondly,as mentioned before, you must keepabreast of economic indicators.

Finally, you must understand andbe able to interpret something knownas “the yield curve” which fortunately,will be the next article in this serieson fixed income investing. Stay tuned!

IntroductionA recent report by the Pew Center on the States

estimates that 17 million low-income children in theUnited States, about one in five of all those between theages of one and eighteen, go without dental care eachyear.1 The same report assessed all 50 states and theDistrict of Columbia on ensuring dental health andaccess to care for disadvantaged children. Pennsylvania,along with eight other states, received a poor grade.

In this article, we examine dental care for disadvan-taged children in Pennsylvania, specifically focusing onthe Medicaid program. Eligibility criteria, covereddental services, expenditures, and access to and qualityof services are discussed. We describe initiativesundertaken by the state and examine policy options forfurther improvement. We find that the Medicaidprogram in Pennsylvania plays a very important role inthe provision of dental services to low-income children.2

Medicaid ImportanceThe Medicaid program, called Medical Assistance in

Pennsylvania, is the underpinning of the health caresafety net. Medicaid was created by Congress in 1965under Title XIX of the Social Security Act. It pays formedical and long-term care for eligible low-incomeAmerican citizens and certain legal immigrants. Financedby the federal government and the state, MedicalAssistance provides health care coverage – the key toaccessing care – for the Commonwealth’s neediest, mostvulnerable residents, while paying providers such ashospitals, dentists, doctors, and pharmacies for treatmentthat would otherwise go largely uncompensated. Children can qualify for Medical Assistance by eithermeeting an income requirement or having a disabilitydetermination. As shown in Table 1, income eligibilityis specified in terms of the federal poverty level (FPL)and varies by age and family size. For example, children

Pennsylvania Medical Assistance:Evaluation of Children’sAccess toDental Services

By Monica Costlow, JD and Dr. Judith Lave


ages 1-6 are eligible for Medical Assistance if their familyincome is equal to or less than 133 percent of the FPL, whichis $33,728 for a family of 4.

Table 1: Medical Assistance Income EligibilityRequirements for Children

*https://www.cms.gov/MedicaidEligibility/Downloads/POV10Combo.pdf

Children also qualify for Medical Assistance if they meetthe Social Security Administration (SSA) level of disability.A child under age 18 is considered disabled if he or she hasa medically determinable physical or mental impairmentwhich results in marked and severe functional limitationsand (i) can be expected to result in death or (ii) has lastedor can be expected to last for a continuous period of notless than 12 months.3 In Pennsylvania, a child who meetsthe disability standards is eligible for Medical Assistanceregardless of the family’s income and assets.4

In FY09, 35.5 percent of children in Pennsylvania,or about one million children, were covered by MedicalAssistance.5 Across the counties, coverage ranged froma high of 60 percent of children in Philadelphia County, toa low of 14.6 percent in Chester County (Figure 1).6

Dental Services

Delivery of Dental ServicesTwo delivery models are used to provide dental services in

Medical Assistance: managed care and fee-for-service (FFS).About 73 percent of children enrolled in Medical Assistancereceive their dental services via managed care, while 27percent access dental services via the FFS network.7

Covered Dental Services for ChildrenFor Medicaid enrollees under the age of 21, federally-mandated services and benefits are provided under the Earlyand Periodic Screening, Diagnostic and Treatment (EPSDT)program. EPSDT is intended to assure the availabilityand accessibility of medically needed medical care and tohelp children and families use them effectively.8 Dentalservices are an EPSDT benefit. Pennsylvania MedicalAssistance covers all medically necessary dental servicesfor children, including9:

• Periodic oral exams • Diagnostic dental services• Preventative dental services, such as sealants and

topical fluoride treatment• Emergency treatment for control of pain and infection• Oral and maxillofacial surgery• Fillings and tooth extractions• Root canal treatments• Prosthetic appliances, such as dentures and crowns• Orthodontics for children who qualify

Age Income limit for a family of 4 (2010)*% of the FPL

0-1 $46,916185%

1-6 $33,728133%

6-19 $25,360100%

Figure 1:FY09 Percentage ofChildren Coveredby Medical Assistance byPennsylvania County

Source: Pennsylvania Department

of Public Welfare Medical

Assistance Enrollment Data and

estimates from the US Census

Bureau


Pennsylvania Medical Assistance: Evaluation of Children’s Access to Dental Services

• Periodontal services for children who qualify• Radiographs/diagnostic imaging

Dental Expenditures for Children

In 2008, Medical Assistance spent about $124.9 millionon dental services for children, or approximately $109 perenrolled child.10 There was considerable variation inexpenditures across the counties in Pennsylvania. Theexpenditures ranged from $72 per child in Tioga Countyto $223 in Fayette County.11

These expenditures are low relative to the national aver-age for all children, which we estimate was about $284 in2008.12 Pennsylvania dental expenditures are relatively lowin part because Medical Assistance dental fees are low. ThePew Center on the States reported that Pennsylvania’sMedical Assistance reimbursement rates were 53.2 percentof dentists’ median retail fees in 2008.13

Access to and Quality of Dental Carefor Children in Medical Assistance

Access to CareThe Pennsylvania Department of Public Welfare (DPW)

provided us with the most recent data on annual dentalvisits for children who are enrolled in ACCESS Plus (FFSMedical Assistance). Table 2 shows that among all childrenand within each age group, the proportion of childrenwith an annual dental visit increased from 2006 through2009.14 In 2006, only 38.72 percent of children had anannual dental visit, while over 55 percent of children didin 2009.15

Table 2: Proportion of Medical Assistance Childrenin FFS Age 4 to 21 with an Annual Dental Visit from2006 through 2009

Source: Department of Public Welfare Data

DPW requires Medical Assistance managed care organi-zations (MCOs) to report on two performance measuresrelated to access to dental care: (1) the proportion ofchildren aged 3 to 20 who had an annual visit and (2) theproportion of enrollees age 4 to 21 with developmentaldisabilities who had an annual dentist visit.

Figure 2 shows the proportion of children ages 3 to 20enrolled in a Medical Assistance MCO who had an annualdental visit from 2005 through 2009.16 While in 2009, lessthan half of the children enrolled in Medical Assistancehad an annual dental visit (42.8 percent), this proportionhas been increasing over time. There is considerable varia-tion across the plans. In 2009, the proportion of childrenwho had an annual dentist visit ranged from 37.6 percentat AmeriHealth to 45 percent at Health Partners.

Figure 2: Proportion of Medical Assistance Childrenin Managed Care Age 4 to 21 with an Annual DentalVisit from 2005 through 2009

Source: Office of Medical Assistance Programs, Division of QualityAssessment. HealthChoices Performance Trending Reports for 2007 and2009. http://www.dpw.state.pa.us/Resources/Documents/Pdf/AnnualReports/2009HealthChoicesPerfTrendingReport.pdf andhttp://www.dpw.state.pa.us/Resources/Documents/Pdf/AnnualReports/2007HealthChoicesTrendRpt.pdf

Figure 3 shows the proportion of Medical AssistanceMCO enrollees with developmental disabilities who had anannual dental visit from 2005 through 2009. Overall,44 percent of these enrollees had an annual visit in 2009.Between 2008 and 2009, there was a slight improvement inperformance of all plans with the exception of AmeriHealth.Again, there is wide variation in each plan’s performance.In 2009, the proportion of children with developmentaldisabilities that had an annual dental visit ranged from 33.4percent in AmeriHealth to 53 percent in Health Partners.

2-3 years

4-6 years

7-10 years

11-14 years

15-18 years

19-21 years

Total

2006 2007 2008 2009

13.39% 19.58% 22.25% 23.95%

44.51% 50.89% 58.68% 59.91%

47.95% 51.97% 59.56% 60.80%

44.22% 47.54% 53.11% 55.50%

40.32% 43.25% 48.01% 50.21%

27.45% 28.39% 35.21% 38.49%

38.72% 42.68% 48.90% 50.59%



Figure 3: Proportion of Medical Assistance Children inManaged Care Age 4 to 21 with Developmental DisabilitiesWho had an Annual Dental Visit from 2005 through 2009


Quality of CareThe proportion of Medical Assistance children who

receive dental sealants is one indicator of quality of care.Figure 4 presents recent trends in the proportion of MedicalAssistance children enrolled in a MCO who turned 8 yearsold and had a protective dental sealant applied to theirteeth during the three years prior to the eighth birthday.Between 2005 and 2009, performance on this measure hasimproved in five of the six plans for which we have data.17

In 2009, the proportion of children reaching the age of 8who had dental sealants ranged from 27.6 percent at Unisonto 56 percent at AmeriHealth.

Figure 4: Dental Sealants for Medical AssistanceChildren in Managed Care from 2005 through 2009


Dental Provider Participation inMedical Assistance

In order for children covered by Medical Assistance toreceive dental services, their families must be able to find adentist who accepts Medical Assistance payment. Analystsoften use the dental participation rate or the proportion ofoverall dentists who treat individuals covered by MedicalAssistance as an indicator of potential access.

The Total Number of Pennsylvania DentistsEvery other year, the Pennsylvania Department of

Health (DOH) surveys all dentists licensed in Pennsylvania.Based on the findings of its last survey in 2009, the DOHestimates that there were 6,261 practicing dentists inPennsylvania in 2009.18 However, since the DOH estimatesdo not include the 398 dentists19 who were licensed for thefirst time in Pennsylvania that year, the total number ofpracticing dentists should be increased to 6,659.

Pennsylvania Dentists Who Accept Medical AssistanceThere are two sources of data on the number of dentists

who accept Medical Assistance in Pennsylvania: DOH andDPW.

• Pennsylvania DOH asked dentists in the biennialsurvey discussed above: “Do you accept any of thefollowing coverage plans: Medicaid, Medicare andPrivate Insurance?” Using the data from the survey,DOH estimates that 871 dentists in Pennsylvaniaaccepted Medical Assistance in 2009.20

• DPW maintains information on every dentist who isenrolled in Medical Assistance. (A dentist must beenrolled in Medical Assistance to be paid for providingservices for Medical Assistance recipients in eitherthe FFS program or managed care plans.21) DPWprepares separate reports on the number of dentistscurrently enrolled in Medical Assistance and thenumber of dentists who received a payment in anygiven year (active dentists). DPW indicates thatbetween May 2009 and April 2010, there were 1,723active Medical Assistance dentists in Pennsylvania.22



We used the DPW data for the number of dentistswho accepted any Medical Assistance payment in 2009, asour estimate of the number of dentists participating inMedical Assistance. We did not use the DOH estimatebecause it underestimates the number of dentists whoaccept Medical Assistance, particularly in counties wheremanaged care is mandatory. For example, according to theDOH data, 127 dentists accept Medical Assistance inAllegheny County.23 However, directors of two large MedicalAssistance managed care plans in Allegheny Countyindicated that their plans had contracts with 220 and 205unique dentists, respectively.24

Using our estimates of the number of practicing dentists(6,659) and DPW data on the number of dentists whoaccepted Medical Assistance (1,723), we estimate that about26 percent of the practicing dentists in Pennsylvaniaaccepted Medical Assistance in 2009.25 There are no recentdata on the proportion of dentists nationally who treatMedicaid patients. In 1999, the United States GeneralAccounting Office surveyed state Medicaid programs.26

Of 39 states that provided information about dentists’participation in Medicaid, 23 reported that fewer than halfof the states’ dentists saw at least one Medicaid patientduring 1999.27 These, and other findings, indicate thatdentist participation in Medicaid, across all states, is low.

Pennsylvania Dentists Accepting New MedicalAssistance Patients

There is considerable turnover (leaving the program andthen reenrolling) among the Medical Assistance population,particularly children. Therefore, it is important to knowwhether Pennsylvania dentists are accepting new MedicalAssistance patients. Using DOH data, we estimate thatapproximately 94 percent of dentists who treated MedicalAssistance patients in 2009 are accepting new MedicalAssistance patients.28 This is a rough estimate given, thatthe DOH data do not include all Pennsylvania dentistswho treat Medical Assistance patients.

Medical Assistance ProgramImprovements

Between 2005 and 2010, Pennsylvania undertook anumber of initiatives to improve the dental portion of theMedical Assistance program. Most of these changes weredirectly applicable to Medical Assistance dentists whoworked in FFS, although some were targeted to MedicalAssistance MCOs.

• DPW required Medical Assistance managed care plansto report on three dental variables.

• To reduce the administrative complexity of theprogram, the number of procedures that requiredprior approval by DPW was decreased. In addition,DPW changed the coding system to create uniformityin coding for both private insurance and MedicalAssistance patients. And, finally Medical Assistancedentists are now able to file for payment electronically.

• DPW increased reimbursement levels for dentalservices, as shown in Table 3. Between 2005 -2008,fees were increased as much as 76 percent for certainprocedures.29

Table 3: Medical Assistance Dental Services WithIncreased Fees

Source: US Department of Health and Human Services: Centers forMedicare & Medicaid Services, Region III (Pennsylvania EPSDTReview Report- Dental Services. April 2008 Site visit) Final Report.December 31, 2008.

• DPW expanded the Access transportation systemto help ensure that Medical Assistance children maketheir dental appointments.30

• In 2008, an ACCESS Plus Dental Care/DiseaseManagement Program was implemented to encouragegreater access to care and to establish dental homesfor individuals less than 21 years of age.31

• DPW added language to the contract that containsprovisions for expanded activities related to themanagement of dental services and provider networkdevelopment for ACCESS Plus.

Year Service

2005

Sedation/anesthesiaBehavior management services (these are services suchas that make it easier for dentists to manage complexpatients )

2006 Behavior management services; Orthodontic services

2007Prophylaxis, fluoride treatments, endodontics, crownsand extractions

2008Fluoride varnish, endodontics, dentures, extractionsand orthodontics



• Pennsylvania increased the types of Medical Assistance-covered dental providers. In 2010, the PennsylvaniaGeneral Assembly passed legislation to expand the dutiesof expanded function dental assistants (EFDAs).32 Theexpanded function dental assistants can now performcoronal polishing, apply fluoride varnish, and takeimpressions of teeth for athletic appliances. Currently,Medical Assistance does not directly reimburseexpanded function dental assistants for services, but itreimburses the supervising dentist for dental servicesprovided by expanded function dental assistants.

• On April 1, 2010, Medical Assistance began toreimburse enrolled physicians and certified registerednurse practitioners for the application of topicalfluoride varnish for eligible children.33 However,although children of all ages can benefit from fluoridevarnish, Medical Assistance restricts the applicationof fluoride varnish by physicians and certifiedregistered nurse practitioners to children from birththrough four years of age.

• In 2010, the state added a dental-related measure tothe pay-for-performance program.

We cannot assess the impact of these policies on MedicalAssistance children’s use of dental services, although wesuspect that the impact of these changes is positive. Wenote that there was a significant increase in annual dentalvisits among all children aged 4-21 covered by MedicalAssistance FFS and MCOs.

Options to Consider for ImprovingDental Care for Children Under MedicalAssistance

Pennsylvania has a shortage of Medical Assistance den-tists, especially in rural areas. This deficit could beaddressed in part by making greater use of other medicalproviders. Children in Pennsylvania see primary medicalcare providers such as pediatricians, physicians, nursepractitioners, physician assistants, and nurses for check-ups and evaluations for school. It is generally understoodthat the primary care setting may be an ideal place todeliver preventive dental services, such as an oral healthassessment, fluoride varnish and parental education, forchildren enrolled in Pennsylvania Medical Assistance.�As a result, many state Medicaid programs are reimbursingphysicians, certified registered nurse practitioners orphysician assistants for dental services. North Carolina’sInto the Mouth of Babes, a preventive dentistry program

that targets children from birth to three years of age,34

utilizes pediatricians, family physicians, nurse practitioners,nurses, physician assistants and other public healthworkers in community health clinics to provide dentalservices to Medicaid children. After successfully completinga training period, providers are eligible to bill Medicaidup to six visits for oral care provided during the first threeyears of a child’s life.35 The covered dental services include:risk assessment, oral screening, prevention services such asfluoride application and education for parents and children.36

Pennsylvania has taken a step in this direction with itscurrent policy to reimburse enrolled physicians andcertified registered nurse practitioners for the applicationof fluoride varnish to children aged zero through four.Pennsylvania could go even further by directly reimbursingother medical providers to expand the availability ofdental care for Medical Assistance children, similar to theNorth Carolina medical model.

Another approach is the state of Washington’s Accessto Baby and Child Dentistry (ABCD) program. ABCD worksto: enroll Medicaid-eligible children by age one; educatefamilies about dental hygiene and eating habits; provideoutreach and case management; train dentists in best carepractices for young children; and create referral networks ofpediatric dentists for children with more difficult treatmentneeds.37 From 1997 to 2008, the number of Medicaidchildren under age six who received annual dental caremore than doubled because of ABCD.38 Pennsylvania couldconsider a pilot program similar to ABCD to improve chil-dren’s dental health.

We acknowledge a final option is to continue increasingdental fees to reach the national Medicaid average of 60.5percent of retail fees.39 However, budget constraints maycause this to be impossible in the current fiscal and politicalclimate.

Conclusion

About one-third of the children in the Commonwealthreceive dental care services through the Medical Assistanceprogram. Although the proportion of Medical Assistancechildren that had an annual dentist visit has increasedmarkedly overtime, but is still low by national standards.According to the Kaiser Family Foundation, about 60percent of children covered by public insurance had anannual dental visit.40 An important factor influencingaccess to care is dental provider participation in MedicalAssistance. We estimated that only 26 percent ofPennsylvania’s practicing dentists treated and billed for at



least one Medical Assistance patient in 2009. That propor-tion is low. This is concerning because 55 Pennsylvaniaareas are experiencing a shortage of dental professionalsand the number of licensed dentists has decreased.41

Pennsylvania has also undertaken a number of importantinitiatives to streamline and improve the Medical Assistanceprogram. We believe that these changes should have apositive effect on children’s dental health, but future dataand formal evaluations of the initiatives will reflectPennsylvania’s grade. It will probably be difficult to increasethe proportion of Pennsylvania dentists without a majorincrease in fees, which is currently unlikely. In the mean-time, Pennsylvania may be able to increase children’s accessto dental services by considering policies to improve thedelivery of dental services in the Medical Assistance program,similar to the North Carolina and Washington models.

Monica Costlow, JD is a Senior Policy Analyst with thePennsylvania Medicaid Policy Center at the University ofPittsburgh. Ms. Costlow earned her JD from the Universityof Pittsburgh School of Law, in addition to an AdvancedCertificate in Health Law. She previously worked as a com-pliance consultant for a multi-specialty physician practice.

Dr. Judith Lave is a Professor of Health Economics,Director of the Health Administration Program, Directorof the Pennsylvania Medicaid Policy Center and co-directorof the Center for Research on Health Care at the Universityof Pittsburgh. Prior to coming to the University ofPittsburgh, she was the Director of the Office of Researchat the Health Care Financing Administration, now CMS. Shereceived her PhD in economics from Harvard University.She is the author of more than 140 scientific publications.

FOOTNOTES1 The Pew Center on the States, The Cost of Delay: State Dental Policies Fail

One in Five Children, February 2010.2 The focus of the article is on children’s dental services, but we would like to

acknowledge that Pennsylvania Medical Assistance covers acomprehensive dental package for most enrolled adults and limitedemergency dental services.

3 Disability Evaluation Under Social Security, September 2008.http://www.ssa.gov/disability/professionals/bluebook/general-info.htm

4 If a disabled child is in a family that has a private insurance policy, than theprivate health insurance policy is the primary payer. Medical Assistance cov-ers those services that are not covered by the private health insurance policy.

5 Pennsylvania Department of Public Welfare Medical Assistance EnrollmentData, Author calculation

6 Id.7 US Department of Health and Human Services: Centers for Medicare &

Medicaid Services, Region III (Pennsylvania EPSDT Review Report- DentalServices. April 2008 Site visit) Final Report. December 31, 2008.

8 Id.9 Medical Assistance Handbook, http://www.dpw.state.pa.us/oimpolicymanu-

als/manuals/bop/ma/Table%20of%20Contents.htm10 Department of Public Welfare Data, Author calculations11 Id.

12 Hiroko et al estimated that in 2005 average dental expenditures per childwere $252, which is about $284 in current dollars. (Hiroko I. et al. “Dentalcare needs, use and expenditures among U.S. children with and without spe-cial health care needs.” J Am Dent Assoc 2010; 141; 79-88.) More currentdata on expenditures per child are not available.

13 The Pew Center on the States, The Cost of Delay: State Dental Policies FailOne in Five Children, February 2010. This is the FFS Medical Assistancereimbursement rate. Managed care payment rates are proprietary.

14 Department of Public Welfare Data. These data relate to children who arecontinuously enrolled (i.e. they may have no more than one enrollmentgap of 45 days) over the measurement year, which goes from January 1 toDecember 31.

15 Id.16 The dates in the graphs are for the reporting year and actually refer to use

in the prior year. In addition, Medical Assistance MCOs determine utilizationrates using either 10 or 12 month continuous enrollees. CMS uses the totalnumber of children enrolled in Medical Assistance, which they determinedto be 27 percent in their 2006 report.

17 Note that data for Gateway for 2008 and 2009 are not available because ofadministrative errors by a dental contractor. Information provided to authorsby Gateway Health Plan.

18 Pennsylvania Department of Health, “2009 Pulse of Pennsylvania’s Dentistand Dental Hygienist Workforce.” Volume 4, October 2009.

19 Pennsylvania Department of State Data20 Pennsylvania Department of Health, “2009 Pulse of Pennsylvania’s Dentist

and Dental Hygienist Workforce.” Volume 4, October 2009.21 Medical Assistance MCOs are able to negotiate fees and reimburse Medical

Assistance non-participating dentists for services rendered on an out-of-net-work basis.

22 Department of Public Welfare Data23 Id. 24 Information provided to authors. These dentists may identify the Medical

Assistance managed care plans as being private insurance.25 Pennsylvania Department of Health, “2009 Pulse of Pennsylvania’s Dentist

and Dental Hygienist Workforce.” Volume 4, October 2009.26 United States General Accounting Office, “Oral Health: Factors

Contributing to Low Use of Dental Services by Low-Income Populations,”GAO/HEHS-00-149, September 2000.

27 Id.28 Pennsylvania Department of Health, “2009 Pulse of Pennsylvania’s Dentist

and Dental Hygienist Workforce.” Volume 4, October 2009.29 US Department of Health and Human Services: Centers for Medicare &

Medicaid Services, Region III (Pennsylvania EPSDT Review Report- DentalServices. April 2008 Site visit) Final Report. December 31, 2008.

30 Id.31 Id.32 Previously HB602, now Act 1933 Pennsylvania Department of Public Welfare, Medical Assistance Bulletin

http://www.dpw.state.pa.us/PubsFormsReports/NewslettersBulletins/003673169.aspx?BulletinId=4526

34 R. Gary Rozier, et al. Prevention of Early Childhood Caries in North CarolinaMedical Practices: Implications for Research and Practice. Journal of DentalEducation, Volume 67, Number 8.

35 Shelly Gehshan and M. Wyatt, “Improving Oral Health Care for YoungChildren.” National Academy for State Health Policy, April 2007.

36 Id.37 The Pew Center on the States, “Washington’s ABCD Program: Improving

Dental Care for Medicaid-Insured Children” June 2010.38 Washington Dental Service Foundation, “Access to Baby and Child Dentistry

Program,” http://www.deltadentalwa.com/Guest/Public/AboutUs/WDS%20Foundation/Strategic%20Focus%20and%20Programs/Access%20to%20Baby%20and%20Child%20Dentisty.aspx

39 The Pew Center on the States, The Cost of Delay: State Dental Policies FailOne in Five Children, February 2010.

40 The Kaiser Commission on Medicaid and the Uninsured, “Dental Coverageand Care for Low-Income Children: the role of Medicaid and SCHIP.”January, 2008.

41 Pennsylvania Department of Public Welfare, Dental Information forStakeholders and Advocates, http://www.dpw.state.pa.us



ABSTRACTThe purpose of this study was to determine graduating dental students’ perceptions about their training andexperience in examination and treatment of infants and their plans to examine infants upon graduation. A surveywas distributed to dental students graduating from Pennsylvania dental schools in 2007 and 2008. Of thereturned surveys, 47.9 percent correctly identified 12 months as the recommended age for the first dental exam.Sixty-five percent of responders felt they would be comfortable performing exams on young children. Thisstudy’s primary objective was to test the association between performance of a clinical exam in a young child,enjoyment of clinical and didactic pediatric dental experience, plans for additional training in pediatric dentistryand willingness to see children younger than two years old in practice. Performing a clinical exam on a youngchild was associated to willingness to see children younger than two years of age in practice. Early exposure(lecture or clinical) to young pediatric patients while in dental school was significantly associated to perceivedcomfort with oral exam of young patients but not to reported willingness to see them in practice. Key words: pediatric dentistry, dental education, infant dental care

A Survey of SeniorDental Students’Experiences withYoung Dental Patientsin Pennsylvania

Kristopher Bennion, DMD1, Andres Pinto, DMD, MPH2,Jena Roath3, and Rochelle G. Lindemeyer, DMD4

Private Practice New Braunfels, Texas1, University ofPennsylvania School of Dental Medicine, Department ofOral Medicine2 , Dental Student, University ofPennsylvania School of Dental Medicine3, and Universityof Pennsylvania School of Dental Medicine, Divisionof Pediatric Dentistry4

*Corresponding author:Rochelle G. Lindemeyer, D.M.DDepartment of Pediatric DentistryUniversity of Pennsylvania School of Dental Medicine240 S. 40th StreetPhiladelphia, PA [email protected]: 215-776-6671FAX 215-590-5990



INTRODUCTIONAccording to the Third National Health and NutritionExamination Survey (NHANES III), although the incidenceof dental caries is concentrated among 20-25 percent ofchildren, dental caries remains one of the more prevalentchildhood diseases. For most Americans, oral health statushas improved during the period of 1988-1994 and1999-2004. However, for youths 2-5 years of age, dentalcaries in primary teeth has increased.1 A study in 2002concluded that a substantial number of children in thiscountry do not receive professionally recommendedpreventive care, particularly dental care.2 In response topediatric dentistry’s move away from a surgical model oftreatment and toward a model concentrated on preventivemedicine, the American Academy of Pediatric Dentistryrecommended in 1985 that the first visit for every childoccur no later than 12 months of age.

The goals of this first visit are to assess the risk for dentaldisease, initiate a preventive program, provide anticipatoryguidance and decide on the periodicity of subsequentvisits.3 In spite of these recommendations, several studieshave indicated that there is a misunderstanding or dis-agreement among general practitioners about these guide-lines.4-8 In a 2001 random survey of general practitionersrepresentative of the 9 regions of the U.S., only slightlymore than half (53 percent) of the respondents were awareof the ADA and AAPD recommendation that a child’s firstdental visit should be no later than 12 months.5 Generaldentists will often be asked to see children for their initialdental visits, as the current shortage of pediatric dentistsmakes it impossible for all age one dental visits to beperformed by pediatric dentists. Although general dentistsmay be available in areas of shortage of pediatric dentists,studies have shown a general lack of willingness of generaldentists to treat young pediatric patients under the age oftwo years.6, 9, 10 Several studies have explored possiblereasons for this, including lack of training or exposure toyoung pediatric dentistry patients while in dental school.11, 12

There is a strong association between a dentist’s willingnessto perform certain dental procedures and their dentalschool training.13, 14 Studies have shown that when dentalstudents were provided with a program directed towardmore exposure to young pediatric patients, they were moreprepared to provide care to these patients after gradua-tion.4, 14-17 A survey sent to 3,559 randomly selected generaldentists in Texas found that the level of dental schooltraining was significantly associated with the dentists’attitudes toward providing dental care to Medicaid-enrolledpreschool-aged children.4 Pre-doctoral clinical infant oral

health programs were established at the University ofMichigan School of Dentistry15 and the University of NorthCarolina at Chapel Hill.16 Surveys were distributed andrespondents who had attended these programs felt betterprepared to conduct oral examinations in children aged0 to 36 months than those who had not participated in theprograms. Similarly, dental students who rotated througha public health based “Infant Oral Health Program” inIowa were reported being more willing to see very youngchildren when compared to dentists who did not rotatethrough such a program.14

Academic and clinical training in pediatric dentistry posea similar challenge. Faculty shortages nationwide haveimpacted the pediatric dental workforce. As discussed bySeale and Casamassimo,11 the educational system has ashortage of faculty trained in the care of children andincreasingly relies on general dentists to teach pediatricdentistry. As a result, the teaching pool becomes limited tomanageable children with a low level of disease. Theyfurther suggested that a relative lack of hands on experiencetreating young children in predoctoral pediatric dentistryprograms might negatively affect access to care in the U.S.Most schools are teaching the first dental visit at 12 monthsor younger, but only half provide actual experiences withinfants.18

The purpose of this study is to survey graduating dentalstudents from the three dental schools in Pennsylvaniaon their perceptions on training in infant oral health (IOH),examining young pediatric patients and their perceivedwillingness to do so upon graduation in their own practices.

The primary hypothesis tested is that there is an associationbetween performance of a clinical exam on a young child,desire for additional training in pediatric dentistry, enjoy-ment of clinical and didactic training in pediatric dentistryand willingness to see children younger than 2 years ofage in practice.

The second hypothesis that will be tested is that there is adifference between exposure to the clinical exam of a youngchild in a lecture setting versus a clinical setting andsubject’s perceived comfort to do an exam in a young child.The third hypothesis to be tested is that there is a differ-ence between observing an operative procedure on a childyounger than 5 years of age versus performing the proce-dure, and subject’s perceived comfort with an oral exam ina young child. The purpose of the analysis is to observe ifthe “intensity” of exposure has any influence on the sub-

A Survey of Senior Dental Students’ Experiences with Young Dental Patients in Pennsylvania

ject’s comfort level with clinical examination of youngchildren and perceived willingness to provide care toyoung children in practice.

MATERIALS AND METHODSSubsequent to Institutional Review Board approval,anonymous paper surveys were distributed by mail tograduating dental students from the three Pennsylvaniadental schools: University of Pennsylvania School ofDental Medicine, Kornberg School of Dentistry TempleUniversity and University of Pittsburgh School ofDental Medicine. The survey consisted of 15 questionsdivided into 3 main categories and based on theguidelines for infant oral health from the AmericanAcademy of Pediatric Dentistry. Five questions relatedto student’s pediatric dental didactic education withrespect to infant oral health. Six questions related tostudent’s experiences in examining pediatric patientsyounger than two years of age, and four questionsrelated to student’s intentions to examine pediatricpatients in their practices upon graduation.

Statistical AnalysisNo formal sample size calculation was performed as theintent was to capture the universe of graduating seniordental students in Pennsylvania. Chi-Square analysiswas used to determine if a statistically significant asso-ciation existed between variables of interest. A doubletailed analysis was set up with a significance level ofp<.05 (Stata v.10.1 Statacorp, College Station, Texas).

RESULTSA total of 400 surveys were distributed. There was aresponse rate of approximately 42 percent with 167returned surveys. Eighty (47.9 percent) of the surveyscorrectly identified 12 months as the recommended agefor the first dental exam. Of the returned surveys,73 (44 percent) reported they had been taught how toperform an infant oral exam in lecture while 41 (24.6percent) stated that they had seen an exam performedin a classroom setting, with another 45 (26.7 percent)having seen an exam performed in a clinical setting(Fig. 1). Only 28 (16.9 percent) stated that theythemselves had performed an examination on a patientyounger than 2 years of age. (Fig. 2). Only 18 percentof participants stated they planned to see patientsyounger than 2 years of age upon graduation. As patientage increased, student willingness to provide dentalcare to children increased as well, with 22.6 percentwilling to see 3-6 year olds, 29.3 percent willing to treat


0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

YES NO

Performed exam themselves

Observed exam performed in

a clinical setting

Observed exam performed in

the classroom

Taught how to perform exam

in lecture

Fig 1. Graduating dental students’ exposure to infant oralexamination on patients younger than 2 years of age.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

12+ years of age7-11 years of age3-6 years of age0-2 years of age

Fig 2. Patient age groups that graduating dental students wouldbe willing to see in their own offices upon graduation.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

Enjoyed their clinical training

Enjoyed their didatic training

Plans on taking classes in

Pediatric Dentistry post graduation

Performed infant exams in

Dental School

YES NO

Fig 3. Percentages of dental students who are willingto see children younger than 2 years of age in their ownoffices based on their experiences in dental school.




7-11 year olds and 30.5 percent stating they would onlysee children over the age of 12 years. Twenty five percentof responders stated that they planned to take continuingeducation dealing with pediatric dentistry upon gradua-tion. Twenty percent of students enjoyed their time in thepediatric clinic and 22.5 percent stated that they enjoyedtheir didactic training in pediatric dentistry (Fig.3).Performing an infant dental exam while in school andperceived enjoyment of clinical pediatric dental trainingwere significantly associated to willingness to see infantsbelow 2 years of age. (Table 1). Perceived satisfaction withdidactic pediatric training was not associated to willingnessto provide care to children younger than 2 years of age.

Didactic and clinical exposure to exam of a young childwas statistically associated to subject’s perceived comfortlevel with this exam. (Table 2) Similarly, both observationand performance of an operative procedure on a childyounger than 5 years of age were associated with subject’sperceived comfort with the clinical exam of a young child.(Table 3)

DISCUSSION Our findings support the concept that there is a linkbetween a dentist’s willingness to perform procedures andtheir dental school training. The main finding of oursurvey was that if a student performed an examination ona child younger than 2 years of age while in dental school,they were more willing to do so upon graduation. In spiteof the guidelines established by the AAPD, a majorityof graduating dental students in Pennsylvania do not feelprepared to follow these recommendations. Furthermore,less than half of the dental students could identify 12months as the recommended age for the first dental exam.

When considered as a single group, students who enjoyedclinical and didactic pediatric instruction tended to haveperformed an infant clinical examination while in dentalschool. However, this association did not yield significantresults when separately evaluating the effect of didacticand clinical training on willingness to see infants youngerthan 2 years of age. However, any level of exposure toinfant exam (didactic or clinical) was associated to senior

Table 1. Analysis of variables that may affect dental students’ willingness to treat pediatric patients younger than2 years of age upon graduation (NS=not significant). Percentages have been rounded.

Performed an Infant examwhile in dental school

Yes: n=28 (17 % of total)

(p=0.024)

Plans on taking classes in pediatricdentistry after graduationYes: n=83 (50% of total)

(NS)

Enjoyed didactic trainingin pediatric dentistry

Yes: n=106 (63% of total)

(NS)

Enjoyed clinical training inPediatric dentistry

Yes: n=124 (74% of total)

(p=0.03)

Yes: n=13 (46%)

Yes: n=21 (25%)

Yes: n=24 (23%)

Yes: n=25 (20%)

No: n=15 (54%)

No: n=62 (74%)

No: n=82 (77%)

No: n=99 (80%)

Willing to seechildren < 2 years of age

upon graduation

dental students’ comfort with performing on oral exam inyoung individuals. The rationale for this finding may lie inthe structure of the question in the survey that addressedstudents’ comfort level with clinical exam of young chil-dren, without mentioning age, versus the specific questionregarding willingness to see children younger than 2 yearsold. Responders may have been comfortable with the exambut not interested in performing continuing care to veryyoung patients. Interestingly, willingness to take continuingeducation in pediatric dentistry did not affect the desire tosee children younger than 2 years of age after graduation.

Our findings are consistent with those of otherauthors13,14, 15, 17, 18 who reported significant associationsbetween attitudes and hands-on educational experienceswith very young children. With the shortage of pediatricfaculty and subsequent decreases in faculty-student ratios,patients demonstrating behavior management challengesor complex restorative care requiring close facultysupervision will probably not be accepted in pre-doctoralclinics.11 Pediatric dental clinics increasingly rely ongeneral dentists to teach pediatric dentistry, who maythemselves feel less competent in dealing with the veryyoung child. Young children are therefore often sentimmediately to the graduate clinics for examination andtreatment regardless of their dental needs. Pre-doctoralpediatric dentistry programs teach students to treatchildren four years of age and older, who are generallywell-behaved.11

This study was limited by the response rate as there ispotential bias in that those students responding were thosewho enjoyed pediatric dentistry. In addition, this study didnot attempt to distinguish those who were planning toenter an advanced program in pediatric dentistry. Studentswho did not enjoy pediatric didactic or clinical experiencein dental school may have been oriented towards otherspecialties, introducing sampling bias.

The majority of graduating dental students from Pennsylvaniadental schools have not performed or seen an infant examperformed while in dental school, and they do not plan tosee children younger than two years of age in their ownoffices upon graduation. This continues to create a barrierto access to care for young children in the state. Withgeneral dentists staffing most of the federally qualified healthcenters in the state of Pennsylvania, it is critical to exposepre-doctoral dental students to clinical contact with veryyoung patients. If general dentists provided screenings andanticipatory guidance for young healthy children, whilereferring children with more extensive needs to pediatricdentists, it is possible that more parents would accessdental care for children at an earlier age. Given the surveydesign, it was not possible to separate responders byacademic institution or geographic area, which could affectthe generalizability of our findings. The results reported inthis study must be interpreted with caution. This studywas not designed with a priori sample size calculation, andseveral groups of responders had lower number of responsesper cell, which could have influenced the statistical analysis.


Table 2. Comparison between classroom instruction, clinical observation of a clinical exam of a child youngerthan 2 years old, and subject’s perceived comfort to do an exam on a young child.

Taught to do an oral exam inchildren <2 yrs old

in the classroom p=0.002

YES

NO

Observed an oral exam on a child<2 yrs old (clinical setting) p=0.01

YES

NO

n=53 n=10

n=57 n=37

n=34 n=6

n=75 n=41

63

94

40

116

Subject’s perceived comfort to doan exam on a young child

Yes No

Total




CONCLUSIONSEighty two percent of graduating dental students fromPennsylvania dental schools do not plan to see childrenyounger than two years of age in their own officesupon graduation. Students who have performed infantexams while in dental school are more likely to be willingto see patients younger than 2 years of age in their ownoffices upon graduation from dental school. Any levelof exposure to pediatric dentistry (lecture or clinical) wasassociated with self-perceived comfort with oral examof young children, but not with willingness to seepatients younger than 2 years of age in practice. Barriers toaccess to care for children in Pennsylvania may be relatedin part to the lack of clinical exposure to infant exams inpre-doctoral dental education in pediatric dentistry.

REFERENCES(1) Dye BA, Tan S, Smith V, Lewis BG, Barker LK, Thornton-Evans G, et al.

Trends in oral health status: United States, 1988-1994 and 1999-2004.Vital Health Stat 2007; (248):1-92.

(2) Yu SM, Bellamy HA, Kogan MD, Dunbar JL, Schwalberg RH, Schuster MA.Factors That Influence Receipt of Recommended Preventive PediatricHealth and Dental Care. Pediatrics 2002; 110(6):e73.

(3) Nowak AJ. Rationale for the timing of the first oral evaluation. Pediatr Dent1997; 19(1):8-11.

(4) Cotton KT, Seale NS, Kanellis MJ, Damiano PC, Bidaut-Russell M,McWhorter AG. Are general dentists’ practice patterns and attitudes abouttreating Medicaid-enrolled preschool age children related to dental schooltraining? Pediatr Dent 2001; 23(1):51-5.

(5) Seale NS, Casamassimo PS. Access to dental care for children in the UnitedStates: A survey of general practitioners. J Am Dent. Assoc 2003;134(12):1630-40.

(6) Santos CL, Douglass JM. Practices and opinions of pediatric and generaldentists in Connecticut regarding the age 1 dental visit and dental care forchildren younger than 3 years old. Pediatr Dent 2008; 30(4):348-51.

(7) Brickhouse TH, Unkel JH, Kancitis I, Best AM, Davis RD. Infant oral healthcare: A survey of general dentists, pediatric dentists, and pediatricians inVirginia. Pediatr Dent 2008; 30(2):147-153.

(8) Salama F, Kebriaei. Oral care for infants: A survey of Nebraska general den-tists. Gen Dent 2010; 58(3):182-7.

(9) Shulman ER, Ngan P, Wearden S. Survey of treatment provided for youngchildren by West Virginia general dentists. Pediatr Dent 2008; 30(4):352-7.

(10) Siegal MD, Marx ML. Ohio dental care providers’ treatment of young chil-dren, 2002. J Am Dent Assoc. 2005; 136(11):1583-91.

(11) Seale NS, Casamassimo PS. U.S. predoctoral education in pediatric den-tistry: its impact on access to dental care. J Dent Educ 2003; 67(1):23-30.

(12) Rich JP, III, Straffon L, Inglehart MR. General Dentists and Pediatric DentalPatients: The Role of Dental Education. J Dent Educ 2006; 70(12):1308-15.

(13) Smith CS, Ester TV, Inglehart MR. Dental Education and Care forUnderserved Patients: An Analysis of Students’ Intentions and AlumniBehavior. J Dent Educ 2006; 70(4):398-408.

(14) Weber-Gasparoni K, Kanellis MJ, Qian F. Iowa’s public health-based infantoral health program: A decade of experience. J Dent Educ 2010;74(4):3633-71.

(15) Wandera A, Feigal RJ, Green T. Preparation and beliefs of graduates of apredoctoral infant oral health clinical program. Pediatr Dent 1998;20(5):331-5.

(16) Lekic PC, Sanche N, Odlum O, deVries J, Wiltshire WA. Increasing generaldentists’ provision of care to child patients through changes in the under-graduate pediatric dentistry program. J Dent Educ 2005; 69(3):371-7.

(17) Fein JE, Quinonez RB, Phillips. Introducing infant oral health into dentalcurricula: A clinical intervention. J Dent Educ 2009; 73(10):1171-7.

(18) McWhorter AG, Seale NS, King SA. Infant oral health education in U.S.dental school curricula. Pediatr Dent 2001; 23(5):407-9

Table 3. Comparison between performing an operative procedure on a child younger than 5 years old, observing aclinical procedure on a child younger than 5 years old, and subject’s perceived comfort to do an exam on a young child.

Performed operative proceduresin children <5 yrs old p=0.004

YES

NO

Observed operative proceduresin children <5 yrs old p=0.001

YES

NO

n=64 n=16

n=44 n=31

n=92 n=28

n=17 n=19

80

76

120

36

Subject’s perceived comfort to doan exam on a young child

Yes No

Total

Building Alliancesfor Better Oral HealthMA Reimbursement forTopical Fluoride Varnish byPrimary Care PractitionersBy Paul R. Westerberg, DDSChief Dental Officer, Department of Public Welfare

As of April 1, 2010, Pennsylvania joined the vastmajority of states whose Medicaid programs offer reim-bursement to primary care physicians and other licensedmedical professionals for the appropriate application oftopical fluoride varnish to the teeth of young children.

This achievement represents a significant milestone in aprocess that has taken years of collaborative effort involv-ing individuals from a variety of concerned organizationsthat included the Pennsylvania Dental Association (PDA),Pennsylvania Department of Public Welfare’s Office ofMedical Assistance Programs (OMAP), the PennsylvaniaChapter of the American Academy of Pediatrics (PAAAP)and the Pennsylvania Academy of Family Physicians(PAFP). Cooperative input from all parties involved has ledto the availability of an effective tool for the preventionof dental caries for strategically-placed health professionals.It has also created potential for a new environment ofinterdisciplinary collaboration leading to overall healthimprovement for Pennsylvanians.

Why is this type of program necessary?The etiology of dental caries is that of an infectious dis-

ease; inoculation with pathogenic bacterial flora generallyoccurring during infancy from contact with caregivers.The most recent NHANES data available pegs the cariesrate for children ages 2-5 at 28 percent, with nearly threequarters of those children having untreated decay.1

Children whose socio-economic status is below the federalpoverty level as a group have a significantly higher dentalcaries rate than children in more affluent circumstances.2

Unfortunately, because there are multiple factorsnegatively influencing access to care for this populationsegment, many young children who are at significant riskfor dental caries are not getting the age appropriate


preventive care that they need. Population estimates forPennsylvania based on age indicate that there are approxi-mately 750,000 children under 5 years of age in the state.3

More than 245,000 of those children (33 percent, approx-imately 1 in 3) are between the ages of 1 and 5, shouldhave experienced eruption of primary teeth and are eligi-ble for MA dental benefits.4 Children eligible for MA areeligible to receive necessary dental services from birthuntil their 21st birthday. However, this cohort of youngerchildren has historically demonstrated a disproportionate-ly low rate of utilization of dental services, including pre-ventive services. Faced with this same dilemma in theirpopulations, many states have sought innovative methodsto get needed preventive services to these young children.Use of medical professionals who are already involvedwith this population has beenidentified as one option. Available national survey datahas indicated that only 1.5 percent of infants and 1-year-olds had a dental visit annually, while 89 percent of thesame group had an office-based physician visit.5 Giventhis level of contact, the involvement of the primary carepractitioner and staff as allies in the battle of cariesdetection and preventive intervention appears to beadvantageous if there are no legal preclusions. Investigationas to compliance with Pennsylvania statute indicatedthat topical application of fluoride varnish by a physician,certified registered nurse practitioner (CRNP), or registerednurse under direction of a physician is within therespective scope of practice for each professional group.

OMAP recognizes oral health care for children andadults as a priority, and in addition to the fluoride varnishinitiative, has implemented other programmatic changesin recent years aimed at improving access to care, espe-cially for children. In September 2008, OMAP issued aMedical Assistance (MA) Bulletin announcing updates tothe Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program Periodicity Schedule. Included amongthe various updates were two dental-related changes.The first added dental risk assessments and referral to adental home as a required component of the periodicscreens occurring at 12 months, 18 months, 24 monthsand 30 months of age. This move marked a changein the timing of the first dental screen required, moving ittwo years earlier on the schedule and aligning therequirement with AAP, ADA and AAPD guidelines. Thesecond change added referral to a dental home as arequired component of every periodic screen, beginningat three years of age – again highlighting to physiciansthe importance of oral healthcare throughout childhood.The bulletin also outlined the specific parameters of what

actions constitute a meaningful referral to a dental home.OMAP issued another MA Bulletin in April 2009 thatannounced the implementation of the Pediatric DentalPeriodicity Schedule outlining recommendations toMA-participating dentists based on American Academy ofPediatric Dentistry guidelines for timely delivery ofpreventive services for children. Of particular note wasreinforcement to the dental community of the recommen-dation that the dental home be established no later than12 months of age.

Through this multi-pronged approach, OMAP isattempting to create an environment of increased awarenessof the issues and collaborative effort between healthprofessionals in both the medical and dental communitiesacross the State to more effectively address and preventearly childhood caries.

What are the program details? In order for an MA-participating physician or certified

registered nurse practitioner (CRNP) to become eligiblefor reimbursement for the topical application of fluoridevarnish through the Pennsylvania Medical AssistanceProgram (MA), they must demonstrate completion of anappropriate training curriculum in oral evaluationtechnique (including the detection of dental caries) andthe topical application of fluoride varnish. To simplify andstandardize this process, with the assistance of the PDAin review of the curriculum, OMAP identified a one-hourCME credit course available on the AAP website as thepreferred means for practitioners to acquire reportabledocumentation of having met the training requirement.The course is available at no charge to the individualpractitioner and provides an official certificate ofcompletion upon passing a post-test for the course.Upon receipt of the CME certificate, the practitionersubmits a copy of the certificate to OMAP via the Divisionof Enrollment in the Bureau of Fee for Service Programs.The practitioner is then eligible to bill OMAP for topicalfluoride varnish application for their patients who areeligible MA consumers under five years of age.

As referenced earlier, these children are seen morefrequently by primary care practitioners during their firstyears of life under the EPSDT program. Once apractitioner identifies a child with erupted teeth and nohistory of a recent visit to a dental home, it is expectedunder EPSDT that a meaningful referral to a dental homeis attempted by the practitioner in addition to the topicalapplication of fluoride varnish. If the child returns tothe physician’s office for the next EPSDT screen visitwithout having experienced a dental visit in the interim,


the practitioner is again responsible to make a renewedreferral attempt to a dentist and should again apply topicalfluoride varnish. Ideally, once a dental home is establishedfor the child, the dental staff should assume responsibilityfor preventive oral health services including fluoridetreatments. The physician should continue to perform anoral assessment and reinforce the importance of regularvisits to the dental home, but should defer application oftopical fluoride in favor of the dental home going forward.

Where do we go from here?In order for the program to be successful there must be

better communication and understanding on the part ofall stakeholders involved. Parents/caregivers must be bettereducated as to the importance of maintaining oral healthof the primary dentition, need for early evaluation,preventive interventions, and appropriate treatment whenneeded. As noted previously, primary care physicians andCRNPs can and should play an expanded role in thiseducation process and facilitate the establishment of adental home for young patients in their care by developingmeaningful communication with dental professionalcolleagues in their communities. The American Academyof Pediatrics has established its own Oral Health Initiativeand offers a wealth of information to physicians andother medical professionals through its association websiteand sponsored events (http://www.aap.org/ORALHEALTH).Pedodontists and general practice dentists who are alreadycomfortable treating young children could outreach totheir community primary care medical colleagues to assistin development of referral networks. The PDA participatedin the development of OMAP’s fluoride varnish programand has repeatedly stated its support for the program inits recent publications. Enthusiastic support at the districtand local society levels will factor heavily in the successof the program by maintaining and hopefully expanding

the referral base for dental homes capable and committedto preventing what is still the most common chronicdisease among children. OMAP remains focused on oralhealth as part of overall physical health and will continueto partner with our MCOs in HealthChoices and casemanagement vendor in ACCESS Plus to improve our pro-grams targeting oral health issues. We face complex issuesin our search for solutions. Combined and collaborativeefforts offer our best chance for success.

To review or download any of the MA Bulletinsreferenced in this article, use the following web link andtype the appropriate number listed below in the box forBulletin Number under Search Option A:

http://www.dpw.state.pa.us/PubsFormsReports/Newsletter

sBulletins/003673169.aspx

Enter 99-08-13 for the Bulletin issued in September 2008on Updates to the Early and Periodic Screening, Diagnosisand Treatment (EPSDT) Program Periodicity Schedule

Enter 27-09-02 for the Bulletin issued in April 2009 onImplementation of the Pediatric Dental Periodicity Schedule

Enter 09-10-08 for the Bulletin issued in March 2010 onapplication of Topical Fluoride Varnish by Physicians andCRNPs

1 Dye, B.A., Tan, S., et al. “Trends in oral health status: United States, 1988-1994and 1999-2004.” National Center for Health Statistics. Vital Health Stat 11, 2007.

2 U.S. Department of Health and Human Services. Oral Health in America:A report of the Surgeon General. Rockville, MD: U.S. Department of Health andHuman Services, National Institute of Dental and Craniofacial Research,National Institutes of Health, 2000.

3 US Census Bureau Data, Annual Estimates of the Resident Population bySex and Age for States and for Puerto Rico: April 1, 2000 to July 1, 2009.Available at: http://www.census.gov/popest/states/asrh/SC-EST2009-02.html,Accessed July 29, 2010.

4 Internal Data, Pennsylvania Department of Public Welfare, Office of MedicalAssistance Programs, June 2010.

5 American Academy of Pediatrics, Policy Statement: Preventive Oral HealthIntervention for Pediatricians, Pediatrics 2008 Dec:122(6).

Paul R. Westerberg, DDS, MBADr. Westerberg is a graduate of Temple University School of Dentistry and began his professional career inprivate practice in the Philadelphia area, serving patient populations in both inner city and suburban locations.After earning an MBA from the University of Delaware, he transitioned to the corporate environment asa program dental consultant and then as Dental Director administering managed care Medicaid, Medicare,and CHIP healthcare services in southeastern Pennsylvania. Moving to public service in state government,Dr. Westerberg originally joined the Office of the Medical Director in the Office of Medical Assistance Programsof the Pennsylvania Department of Public Welfare as the Executive Dental Consultant. He has served as theChief Dental Officer for the Department since 2002.


Sometimes, the most satisfyingresults are those achieved from over-coming significant challenges.

In the continuing efforts to find newopportunities to treat those indigentpatients who lack insurance or whomay not be eligible for reduced-costprograms, PDA member dentists arealways searching for new ways toimprove access to care. We all realizethat Pennsylvania has been one of themost difficult state environments toenact improvements to the system,with low reimbursement levels and acumbersome structure.

Then there are the patients withemergencies who often have no placeto go and dentists who have no placeto send them. Purely volunteer effortsare often difficult to maintain. As aresult, working toward an access tocare plan that will have more long-termsustainability may necessitate startingsmall and working up to somethinglarger.

What began as just one more prom-ising idea in a local dental society’scontinuing efforts to improve accessto care has now blossomed into amuch broader success story that couldhave long-lasting impact for theunderserved population of south cen-tral Pennsylvania.

Considering the group of dedicatedindividuals involved, their persistence

and success shouldn’t really be asurprise.

The Harrisburg Area Dental Society(HADS) has a reputation for beingone of the more active societies in ourstate. Its members have achievedtremendous results in numerousinitiatives the last several years,including two public relations effortsin 2009 – a 30-minute televisionprogram broadcast on ABC27 here inHarrisburg, largely due to the hardwork of HADS vice president Dr.Marianna Clougherty, that included aphone bank for patients; and a specialinteractive dental exhibit from theNational Museum of Dentistry thatHADS brought to the Whitaker ScienceCenter in downtown Harrisburg,with then HADS secretary Dr. AshleighLancaster-Fishel coordinating thiseducational event.

In their latest foray, HADS membershave been working for the last twoyears toward their goal of a compre-hensive program to provide bettercare for the neediest patients in theircommunities. Developing this accessmodel, and working through all of thekinks, has been anything but easy.

“We didn’t want to do somethingthat was only going to be good for ayear,” said Dr. Andrew Gould, one ofthe HADS members who spearheadedthis process. “We talked about keeping

it functional, long term.”The seeds were planted in 2008

with the creation of HADS’ Task Forceon Access to Care.

Dr. Gould, who was HADS presidentat the time, said the idea came about,in part, from a desire to change publicperception about the good work den-tists do in their communities.

“We were in a HADS meeting and atouchy subject had come up. It had todo with our governor,” Dr. Gouldsaid. “He had made a statement in thenews about ‘our health care profes-sionals not giving back to the commu-nity.’ We quickly realized that ouraccess to care problems were not onlydue to the obvious reasons – apathy,lack of funds, initiatives – but also thepublic’s perception of what we ashealth care providers actually give tothe community.”

Dr. Gould and his colleagues decid-ed to launch the HADS Task Forceon Access to Care, which has evolvedinto an official standing committeewithin the HADS Executive Committeebranch (Committee on Access to Careand Outreach).

The group’s mission statement is,“To act as a conduit of emergencydental care for the underserved dentalpopulations and help match thosedental needs with the availableresources in our dental community.”

HARRISBURGSMILES

RESHAPING ACCESS TO CAREIN CAPITAL REGION

By Rob Pugliese, Director of Communications


Dr. Gould further expanded on thismission.

“The purpose of this committeewas to provide the public with rawnumbers of what we, as dentists, giveback to the community in initiativesthat are already present and working,come up with sheer numbers toprovide the public – and governor –of what the results are of what dentistsare already doing, make the publicmore aware of Access to Care andwhat they can do to help, and evenwhere they can go to receive dentalcare, and finally, the purpose of theTask Force was to create a program toprovide dental care to the under-served in our area,” he said.

The first part of the committee’spurpose came rather easily. The FifthDistrict Dental Society ExecutiveCommittee, under the direction ofthen Fifth District president Dr. JimBoyle, created a survey to ask areadentists what they were doing forAccess to Care without receiving anycompensation. This included all of thehours that dentists donate to theunderserved at their own practicesand offices without billing or collectingany payment. Gould explained thatthe total hours of pro bono work fromHADS members is higher than what

most people would imagine, and thatit is very difficult to place a dollarfigure on the dental care donated tothe underserved in the Harrisburg areaand throughout the Fifth District.

“Like many of my colleagues,volunteering within the community isa big part of [our] joy in doingdentistry everyday. I do a lot of workfor the West Shore School Districtand have a relationship with themwhere they will call me and I will seetheir kids for no fee,” Dr. Gould said.“I also volunteer my time with HADSwhen we do clinics and publicappearances, and finally, I have donatedmy time at the Mission of Mercy –a church organization in downtownHarrisburg run within the ChristLutheran church, which HADS pastpresident John Kiessling has been incharge of for more than five years.”

The next phase of the task force’sgoals, and a monumental one — tocreate a comprehensive program tocare for the underserved — has takentwo years to implement due to itscomplexity, clearing all of the signifi-cant logistical hurdles as the initialidea has grown exponentially.

The HADS Task Force membersoriginally thought that they wouldcreate a network that would link all

of the underserved population, bothadults and children, to a phone num-ber or a central station where theywould receive a dental screening.The task force considered HarrisburgArea Community College (HACC) asa possible central station for thiseffort before realizing that there wereseveral issues that would have to beresolved, including funding.

“We all had ideas and thoughts, buthad trouble getting the plan in place.We were running into logistics prob-lems and how to put it all together –especially something as monumentalas a central station and a publishedphone number,” Dr. Gould said.

At that point, Highmark BlueShield contacted Dr. Gould to set upa meeting to discuss HADS efforts.Eventually, Dr. Gould and Dr. HarryMeyers, who chairs the HADSCommittee on Access to Care andOutreach, took part in a roundtablediscussion at Highmark’s headquartersthat greatly enhanced the proposedefforts. Drs. Gould and Meyerslearned that Highmark had moneyavailable for access to care initiativesand would be accepting proposals forgrants. This was a valuable resourcepreviously unknown to HADS.

All of this contributed to the con-struction of an umbrella organizationcalled Harrisburg SMILES, whereseveral partners have been able tocoordinate efforts. A coalition wasborn, and HADS began fine-tuning amodel with two central screening orcontact areas serving Harrisburg-areaboth the East and West Shores of theSusquehanna River, with a networkthat would help those two entitieshandle the treatment of needy patientsand refer them to get the proper treat-ment they need.

“We found out that Hamilton HealthCenter in Harrisburg, Christ LutheranChurch, and Good Hope Ministrythrough Holy Spirit’s Health Shareprogram are willing and able to help

The group’s mission statement is,

“To act as a conduit of emergency

dental care for the underserved dental

populations and help match

those dental needs with the available

resources in our dental community.”


H A R R I S B U R G S M I L E S

us in our initiative,” Dr. Gould said.“All we need now are the HADS vol-unteers to pull our network together.”

Members of this new coalition –HADS, HACC, Hamilton HealthCenter, Christ Lutheran Church, andHoly Spirit’s Health Share – gatheredfor monthly, sometimes weekly,meetings for the past two years,exchanging their ideas in an effort tomake all the logistics work.

Hamilton Health Center has beenan effective partner for HADS in thiseffort because of its modern facility,full-time staff, and availability of afterhours care and transportation forpatients, and finally, much of the workdone there is without any cost to thepatient.

“The coalition also met with socialservice organizations in a town hallmeeting format and sought their input,”Dr. Gould said. “You can not imaginehow many calls we, as a dental society,get in reference to social service organ-izations’ clients needing dental care —usually emergency care, which is whatthis initiative is primarily focused on.We want to include all the socialservice organizations in the future sotheir needs are also met.”

Pastor Jody Silliker of ChristLutheran Church in Harrisburg is theIntake Coordinator for the East Shorepatients in Dauphin County. ChristLutheran Church already housesseveral community and health-relatedministries, including a dental clinicrun by Mission of Mercy two dayseach month. Through donations fromarea businesses and HADS dentists,Christ Lutheran now houses twofully-equipped operatories capable ofdoing all facets of dentistry in theirchurch.

“The plan is, now that the dental

clinic is established, Christ Lutheranwill provide this ministry twoadditional days a month, using HADSvolunteer dentists who will go there,”Dr. Meyers said. “Jody will referpatients to other partners when herchurch or Mission of Mercy cannotmeet that need.”

In addition, The Health ShareProgram of Holy Spirit Hospital, willbe working with many patients incommunities in Cumberland Countyand Perry County on the West Shoreof the Susquehanna River. SusanWilliams is the west shore coordinatorfor Harrisburg Smiles, and refers todentists in their offices on the westshore.

“Prior to working on this project, theHealth Share Community Partnershiphad already recruited several dentistsand an oral surgeon to provide dentalcare to individuals who were in needof immediate care. After meeting withthose affiliated with Harrisburg Smiles,I learned that there were even moredentists who were willing to work forthe greater good,” Williams said.

Williams had previous experienceworking with Dr. Meyers, through hisaffiliation with Health Share of HolySpirit.

“When working with him andspeaking with him, it is obvious thathe is a caring individual who onlywants to see the best care given to allpatients,” Williams said. “Afterbeginning work with the HarrisburgSmiles Project and making referrals toDr. Andrew Gould, the sameexuberance portrayed when workingwith Dr. Meyers also comes throughin Dr. Gould’s work. Both of theseindividuals show a tremendous com-passion for those in need.”

HACC’s dental hygiene and

Expanded Function Dental Assistant(EFDA) programs are providingradiographs, clinical exams and dentalprophylaxis to needy patients as well;and, if there are restorative needs,patients may be sent to the EFDAclinic or Hamilton Health Center tohave basic restorations placed.

HADS member dentists will bevolunteering to see patients in theirown offices gratis or may go to theseother sites to treat patients. Some havetaken part in past by volunteering atHACC or Hamilton Health when therehave been programs for the under-served sponsored by United Concordiaand the Highmark Foundation.

Harrisburg SMILES is up and run-ning, and will be fine-tuning theprocess in months ahead. Getting allHADS member dentists to volunteerand assist in this initiative hasquickly become a primary goal of thecoalition.

“Without volunteers, the patientsreferred through our screening partnerswill never get seen in a timelymanner. HADS can’t continue to relyon the same individuals donatingtheir time,” Dr. Gould said. “It has tobe a group-wide effort.”

Dr. Gould added that furtherevaluating how Harrisburg SMILEScan possibly tap into Highmark grantfunds that can be used to help aidethe needy Harrisburg-area patientsmore effectively is another obstaclethis group of volunteers will considerin the very near future.

“As we continue to evolve, we willtry to adapt and meet the community’sneeds as best as possible,” Dr. Meyerssaid.

“I’m really, really excited about thisand I’m really proud of the work we’vedone,” Dr. Gould added.


H A R R I S B U R G S M I L E S

Harrisburg SMILES already has more than 40 PDA members who have volunteered in this effort. To become a part of thisand volunteer with Harrisburg SMILES, contact Dr. Harry Meyers at (717) 697-7000, Dr. Andrew Gould at (717) 774-7700or Dr. John Kiessling at (717) 657-3290.

“Besides just learning how things are done in Harrisburg, I actually felt as if we

made a difference. Both the officials and the aides took the time to listen and ask

pertinent questions. It is truly a good experience. Only after you have done it do

you feel like you have made a difference.”

— Dr. Thomas Nordone, First District Trustee, first time attendee

“I truly had a great time and experience with my friend and colleague Dr. Mike

Christiansen. It was also rewarding to be teamed with two dental students, one

from Pitt and one from Temple. They were not afraid to share their thoughts

and their candor was very refreshing. It was awesome that they took their time as

well to attend. PDA did a fantastic job with the organization of the whole day.”

— Dr. John Pagliei, Second District, second time attendee

DAYON THE

HILLJune8,2010


DAYON THE

HILL

“Day on the Hill is the single mostimportant day on the PDA calendar. Ourentire year should revolve around this day.We, as a profession, need to be proactivein dealing with our legislators so that wehave a strong voice in the policy-makingprocesses that directly affect us. Face-timewith our own personal lawmakers is thekey to having a successful Day on the Hill.

Day on the Hill will protect the professionas it currently stands and will hopefullysafeguard it perpetually. I encourage every-one who has a vested interest in dentistryto participate in Day on the Hill! Imaginethe message we could send to Harrisburgif several hundred or even a thousanddentists, dental students and membersof the Alliance flock our Capitol instead ofthe one hundred or so we have recentlyhad attend.”

— Dr. Brian Mark SchwabFourth District and Associate Editor, third time attendee

“I have been participating in PDA’sDay on the Hill for about 10 years. Frommy very first experience, I have felt thatthis time is well spent! The legislators reallylisten and try to understand the issues webring before them. Senator Robbins, mystate senator, said that they (the legislators)couldn’t be experts on everything so theyneed to reach out to their constituents toget information and a better understandingof the how any bill being considered isgoing to affect those involved.”

“Every dentist should find the time tocome to the Capitol and lobby for realisticand fair laws that will guide our profession.The legislators will be passing newlegislation and it will affect the way we canand do our work. If we don't speak outand be heard on the issues, then we haveno room to later complain about the lawsthat govern this profession.”

— Dr. Dennis CharltonPresident-elect, 9th District


Dr. George Bullock shares informationwith Dr. Amanda Horn and Dr. Priya Thomas.

Dr. Richard Clark with state Senator,Sen. Ted Erickson.

CEO Camille Kostelac-Cherrybriefs dental students prior toSenate hearing.

Dr. Pete Carroll headsto the Capitol.

Dental Student Testimonials

“This was my first time attendingPDA’s Day on the Hill. I was motivated toattend because of the numerous issuescurrently pressing the dental profession.Dentistry is my career, so I want to protectit from the vulturous insurance companiesthat destroyed the medical profession.It is important to participate in Dayon the Hill to protect your patients, yourprofession and yourself by being activelyinvolved in legislative efforts. Apathy nowleads to deterioration later.

I was able to sit in on the Senate InsuranceCommittee meeting to see the passing of thenon-covered services bill. It was incredibleto see a bill that directly affects my professionbeing passed by my elected officials.

PDA organized this event very effectivelyand it went off without a hitch. I lookforward to attending next year!”

— Christopher AdamsTemple University

“This was the first year I participated inPDA’s Day on the Hill. I wanted to becomeproactive about Pennsylvania dentallegislation as this has a direct impact on ourfuture careers. Also, this was a greatopportunity to get involved with PDA.

This is an important event because ourvoices are heard and actually listened to.We have a say in legislation, we just needto be proactive.

From my perspective, the top three reasonssomeone should attend a future Day on theHill are to:• Meet PDA and see how the organization

is working for us. • Meet and network with local dentists.• Become educated about the overall law-

making and lobbying process.

Thank you to PDA for organizing a verysmooth day.”

— Jordan BowerTemple University

DAYON THE

HILL


Dr. Richard Clark (right) talks policywith Sen. Ted Erickson.

Sen. Kim Ward with dental studentsBen Drane and Nicole DeShon.

Dr. Karin Brian delivers PDAmaterials to a legislative office.

In Memoriam


Dr. John W. StaubachBy James M. Boyle, III, DDS, MS

In July, both the BaseballHall of Fame and Football Hallof Fame honored their giantsof the game, both past andpresent. Induction ceremonieswere held respectively inCooperstown, New York andCanton, Ohio. In York,Pennsylvania on July 22, thePennsylvania DentalAssociation lost Dr John W. Staubach, a true hall of famerand giant of organized dentistry.

John was born in Basel, Switzerland, on June 25, 1933.He graduated from Sparks High School of Sparks, Marylandand, following service to his country in the United StatesArmy during the Korean War, graduated in 1959 fromFranklin and Marshall College in Lancaster. Dr. Staubachearned his dental degree from the University of Marylandin 1963.

Dr. Staubach represents everything positive andprofessional in organized dentistry. His exemplary leadershipand work ethic in the York County Dental Society led tohis service as president of the Fifth District Dental Societyin 1984. John continued his tireless work at the state levelin various committees and in 1994-1995 he led PDA aspresident. Following his term as president, Dr. Staubachcontributed at the national level where he served four yearsas Pennsylvania’s trustee to the American Dental Association.

Dr. Staubach was a member of the Academy ofGeneral Dentistry and a Fellow of the International Collegeof Dentists, as well as the Pierre Fauchard Academy.

“John was a giant in our profession and in his community,as you can see from his extensive resume. All who knewhim, knew him to be a mentor and a role model,” said PDApresident Dr. William T. Spruill. “There are many incurrent leadership who owe huge thanks to John for beingthe catalyst for our involvement by his personal exampleand guiding light.”

The success of organized dentistry is dependent on agrassroots methodology. As Babe Ruth was to home runs,John Staubach was to the grassroots work of organizeddentistry.

Regardless of level of office he served, many memberdentists of York County can recall a phone call or visit from

John Staubach to discuss pending legislation, a politicalcandidate running for office or to seek an opinion of issuesaffecting their practice. John was a mainstay at all meetingsand was uncanny at mobilizing ideas and frustrations ofmembership into solutions and actions. Dr. Staubach wasapproachable, he listened, and was easy to find becauseanyone involved with the PDA or ADA knew his lovely wifeof 54 years, Lois, was by his side. It was not just John butboth he and Lois who reached out to new dentists and theirfamilies to welcome them to York County or state meetingsand receptions.

“His gentle and elegant wife, Lois, was ever at his side;a testimony to their love for each other and their commit-ment to all things worthy of endeavor,” Dr. Spruill said.

John and Lois raised two beautiful daughters, Melodieand Heather, and was father-in-law to two gentlemen. Johnenjoyed everything life had to offer including a good joke,which he loved to share. Ask any of his five grandchildrenabout their grandfather’s favorite joke and a warm, lovingsmile appears.

“I am thankful for the gift of Dr. John Staubach and forhis contributions to so many aspects of all of our lives,”Dr. Spruill said. “His presence, his guidance and his wisdomwill be missed.”

We in organized dentistry lost a hall of famer, yet hislegacy remains as an example to us all. Rest in peace, John,and thank you for all you have done.

PDA received the following letter from Monica Robinson,Dr. Staubach’s granddaughter. He wrote the letter to heron April 19, 2003.

Dear Monica,Today you asked that I write a letter to you about the

future. You know, the future is not limited to the unfore-seeable years ahead. Whether they be 5, 10 or 15 matterslittle because you see I consider tomorrow the future. Andbecause of that, as the stairs seem to become steeper anddistances seem greater than in years past and everyoneseems to be in a greater hurry than I. I am reading moreand writing less. I cherish sitting in the yard or porch withyour grandmother while watching the brilliant sunsets,which promise a new tomorrow. I relish the sight of thewild ducks and Canada geese gracefully gliding, on silentwings, out of the early morning mist with their plaintivecries and gracefully landing on the pond as they too greet


In Memoriam

the new day. Who cannot help but enjoy the sight of deercautiously slipping from the woods in order to browse inthe fields at evening time.

I don’t fuss as much about the weeds in the garden orthe peeling paint on the barn. I spend more time withfamily and friends. I have come to realize that life shouldbe a pattern of experiences to savor and hold dear in ourmemories, not one to endure.

With the passing of time it becomes less important tosave anything but rather more important to share withfamily and friends.

I don’t dress up as much as I used to except perhapsfor church. But I try to always wear a smile — even for theclerks at the grocery store.

Continued learning is not an option to set aside. I try toexpand my vocabulary. I want to see, hear and do differentthings now before tomorrow comes.

I’m not certain what others would have done had theyknown they would not be here for tomorrow that we allseem to take for granted.

I think I would have communicated more with familymembers and a few good friends. And I might have been abetter person had I called those with whom I had squabblesand apologized.

It’s these little things (perhaps not so little after all whenI think about it) left undone that would make me angry if

I knew my remaining hours were limited. I’d be angrybecause I had not written certain letters or notes that Iintended to write one of these days but had not set asidebecause I was “too busy.”

I, at times, am sorry that I didn’t tell my family, mymother and father-in-law and yes even my own parentsjust how much they meant to me.

I’m trying very hard not to put off, hold back or saveanything that would bring more laughter and luster to growgrandma’s and my lives. And each morning, as days passall too quickly, I open my eyes and tell myself this is aspecial day and how lucky I am to be married to grandma.You see Monica, each day, each minute, each breath wetake truly is a gift from God.

Monica, live your life to the fullest, never stop learningand look to tomorrow — the future.

Remember, life may not be the party we hoped for, butwhile we are here we might as well dance.

Love,Grandpa

Perhaps someday Monica, when you’ve grown older andthe ink has long since faded on this paper – you too willunderstand what I have been trying to tell you.

Dr. Charles M. Ludwig

Dr. Charles M. Ludwig, aformer PDA president and statepublic health dentist, died onJuly 23 in Lititz. He was 81.

He was born on April 12,1929 in Jersey City, N.J., theson of German immigrants. Heearned his BS from St. Peter’sCollege in 1950 and his DDSfrom Temple University Schoolof Dentistry in 1954.

Charlie served as a Lieutenantin the United States Navy Dental Corps from 1954-1956.He opened his first practice in Ringwood, N.J. in 1956. Hemarried Betty Olene Gourley on August 31, 1957 inMount Lebanon, Pa. In September 1960, the family movedto Harrisburg and soon after he became involved withorganized dentistry in 1963.

He served as president of the Harrisburg Area Dental

Society in 1973-1974 and then made a great impact aspresident of PDA in 1986-1987.

“Charlie was the best friend to the Pennsylvania dentists.He stood on principle,” said Dr. Harry Meyers. “And hisprinciples primarily were two things – One, the integrityof the dental profession, that it not be dictated to by thirdparties, and two, the patients. He was the first public healthdentist in the Commonwealth of Pennsylvania.”

“He sacrificed so much for the ability of Pennsylvaniadentists to practice without undue interference from thirdparties,” Dr. Meyers added.

Dr. Meyers recalled times when Dr. Ludwig rallied sup-port for causes important to dentistry and how Dr. Ludwig’sclose friendship with the late state Sen. John Shumakerwas so valuable for PDA and the profession of dentistry.

In 1993, Dr. Ludwig received the Distinguished ServiceAward from the Pennsylvania Society of Orthodontists, thefirst general dentist to receive this award. After retiringfrom private practice in 1994, he worked for the PennsylvaniaDepartment of Health from 1994-1999. In 1999, he wasappointed to the Northeast Regional Board of Dental

Dr. Morris MalmaudBoca Raton, Fla.Temple University (1942)Born: 3/28/18Died: 8/3/02

Dr. Lewis N. BernsteinBoynton Beach, Fla.Temple University (1936)Born: 11/02/12Died: 12/1/03

Dr. Roger M. OwensOcala, Fla.Temple University (1944)Born: 12/5/16Died: 12/18/03

Dr. Martin W. PollockNew York, NYUniversity of Pennsylvania (1943)Born: 5/7/21Died: 2/29/04

Dr. I. Irwin FisherBoca Raton, Fla.Temple University (1938)Born: 3/7/16Died: 8/19/04

Dr. Don C. DonaldsonNew KensingtonUniversity of Pittsburgh (1945)Born: 10/29/22Died: 8/23/04

Dr. Isadore B. MandelDelray Beach, Fla.University of Pittsburgh (1945)Born: 12/14/21Died: 2/11/05

Dr. Roy A. SmithBurbank, Calif.University of Pittsburgh (1927)Born: 6/11/06Died: 2/16/05

Dr. Jacob D. PromishPhiladelphiaTemple University (1932)Born: 2/11/09Died: 9/9/05

Dr. Clifford C. PiersonPortland, Ore.Temple University (1936)Born: 11/24/10Died: 10/25/06

Dr. Benjamin L. MandelGlensideTemple University (1937)Born: 6/26/14Died: 12/27/06

Dr. Irving AbramsPhiladelphiaTemple University (1947)Born: 8/6/20Died: 5/1/2007

Dr. Dominick J. MaldonatoScrantonTemple University (1932)Born: 12/28/08Died: 12/16/09

Dr. Daniel G. GenthnerBethlehemUniversity of Pennsylvania (1955)Born: 5/28/30Died: 5/21/10

Dr. Richard A. SmithFort Myers, Fla.Washington University (St. Louis)Born: 4/25/27Died: 6/24/10

Dr. Floyd E. BakerPhiladelphiaMeharry Medical College of Dentistry(1946)Born: 3/28/19Died: 7/5/10

Dr. Ralph L. CohenSewickleyUniversity of Pittsburgh (1952)Born: 2/13/23Died: 8/11/10

Dr. Jeffrey E. KannerYardleyTemple University (1970)Born: 10/19/45Died: 8/18/10

Examiners, for whom he administered exams until thespring of 2010. Charlie also worked from 2003 to 2006doing contract work at Hamilton Health Center in Harrisburg.

“Charlie was a man who would passionately throwhimself into whatever he was involved in,” said Dr. SamuelSelcher. “As PDA president, he spent countless hourswalking the Capitol halls on behalf of dentistry. As PublicHealth Dentist, he did all he could with limited resourcesto improve the dental health of Pennsylvania.”

Charlie was also very active in community service workand he served two years as an Elder at Paxton PresbyterianChurch.

He will be remembered for his dedication to his profession,his willingness to help others and his great sense of humor.

“His legacy is that he fought to maintain our integrity asa profession, free of external interferences, yet he very muchcared that the patients would receive appropriate dentalcare,” Dr. Meyers said.

Charlie was predeceased by his parents and a brother,Howard, in 1970. He is survived by his current and ex-wives,his two children, Donald Ludwig (of Langen, Germany)and Carol E. Bell (of Harrisburg), two step-children, DianeDavenport (of Baltimore, Md.) and Doug Steinhauer (ofLancaster). He is also survived by his grandchildren, Erichand Sarah Bell, his step-grand-daughters, Ellexia, Vallerieand Abigail Davenport, a brother, retired Colonel Wesley A.Ludwig (of Leavenworth, Kan.) and a sister-in-law, DorothyTrehou Ludwig (of Highland Lakes, N.J.).

In Memoriam


What’s Your Status?By Dr. Brian Mark Schwab, AssociateEditor

In the online social networkingera, things just happen differently thanthey would have prior to the myriadof technological advances and accessthat have shaped the first decade of the21st Century.

In previous columns, we havefocused on the various social network-ing sites Facebook, MySpace, LinkedInand Twitter. We have also focusedon PDA’s new Social Networking site,which is up and running and readyfor business. In addition to promotingour new site, we have also providedarticles about how easy social network-ing is. A 5 year old can do it and socan a 105 year old. Now we are goingto focus on some of the minor aspectsof social networking that can helpmake your experiences just a littlemore exciting and enjoyable.

I am certain that some of you aretotally new to social networking. Youhave figured out how to search forsomeone, you probably have uploadeda picture and you probably haveemailed or posted a message forsomeone you know. Now it is time toexplore the many additional featuresthat are available to you.

On Facebook, one of the optionsyou have on your profile page is toenter “What’s on your mind?” You typesomething in the box and hit “Share”and it will appear on your friends’page the next time they log into theiraccount. You could post something

minor like, “When is this heat goingto break?” or something exciting suchas, “I just had my first hole-in-one!”or something else of significance orinsignificance to you. This is yourway on Facebook of communicatingto your pals without having to email,text message or telephone them to tellthem what is going on.

On Twitter, you actually do thesame thing but it is known as a “Tweet.”On the PDA’s social networking site,you are prompted to enter “What’s onyour mind? Question for otherMembers?” This is where you can postgood news, bad news, inquiries aboutdental products, materials, legislationor virtually anything you’d like. It isa forum that is available only to PDAmembers who have registered to usethe site. It is the hope of the PDABoard of Trustees and staff membersthat members will utilize this excellentforum to openly discuss and debatequestions and topics introduced.There is a forum for general dentists,specialists, public health and volun-teering, new dentists and others.Literally, there is a forum for everyoneand if you have an idea for a newforum, please contact Jessica Forte [email protected].

Social media can be used as a toolto reach out to people whom youwould otherwise not have direct accessto. Imagine the capability of beingable to connect a dentist in Philadelphiawith a dentist in Erie. Suppose thePhiladelphia dentist posted that she isplanning to purchase a Panorexmachine and she wanted feedback on

two different brand names. The dentistin Erie just purchased one and reallyliked the customer service and specialfinancing he received from companyA versus company B. In literally 10seconds, he could share this excellent,firsthand information with a colleague.No long distance phone calls, nolengthy emails, none of that. Thesetwo dentists may never have even “metone another” had it not been for thePDA’s social networking site. Thisexample represents the type of activitythat we would like to see.

Our site is a dynamic fusion ofvision and mission; to connect mem-bers together for the common benefitand to offer member value throughPDA membership. Imagine how thissite can be used to quickly distributeinformation on legislation. I hopeyou currently receive CapWiz alerts.Unfortunately, there is no method todiscuss the CapWiz alerts with yourcolleagues or leaders. Those days areover now, as we have an excellentway to discuss activities in Washingtonand Harrisburg and all around thestate right at our fingertips. Ourimpact will be greater if we can educateeach other and promote legislationthat will have a positive impact onour profession.

If you have not yet taken the time tolog into www.community.padental.orgplease take 10 minutes and explorethe site. In addition to using it as adirect connection to PDA, you will findit easy and fun to use. Hope you havea great time social networking!

Cyber Salon


Awards & Achievements


Your Representation on the National LevelPDA would like to recognize and thank all of our volunteers who have given their time serving on ADA councils and com-mittees during 2009-2010. Following is a list of PDA members and the ADA group that they served on during the past year:

Dr. Gary S. DavisCouncil on Access, Prevention and InterprofessionalRelations, Vice Chair

Dr. Ronald K. HeierCouncil on ADA Sessions

Dr. John B. NaseCouncil on Communications

Dr. Lauri A. PasseriCouncil on Dental Benefit Programs

Dr. Jon J. JohnstonCouncil on Dental Practice

Dr. Thomas W. GambaCouncil on Ethics, Bylaws and Judicial Affairs

Dr. Herbert L. Ray Jr.Council on Government Affairs

Dr. Nancy R. RosenthalCouncil on Membership

Dr. Craig A. EisenhartCouncil on Members Insurance and Retirement Programs

Dr. Stephen T. Radack IIIJoint Commission on National Dental Examinations

Dr. Jennifer DavisCommittee on the New Dentist

Dr. Jay R. Wells, IIIAmerican Dental Political Action Committee

Third-Party ComplaintsExperiencing problems with third-

party insurance? Let PDA know withthis easy to use Third-Party Complaintform. This form gives dentist anddental staff the opportunity to providePDA and ADA with basic informationregarding payer concerns. Theinformation received will be used tokeep a close watch on carrier trendsand problems.

PDA’s Dental Benefits Committee(DBC) meets regularly with third-partyinsurance representatives to discussissues raised by members. This ongo-ing dialogue has resulted in greatercooperation in billing procedures,faster reimbursement timelines andnetwork referrals. Dentists throughoutPennsylvania need to report theproblems they are having with third-party payers so PDA may advocateeffectively during these meetings.

PDA is a dedicated advocate for thedental profession regarding insuranceissues. Members can assist PDA inthis effort by keeping DBC informedof the insurance problems encoun-tered in daily interactions. Questionsmay be addressed to our new govern-ment relations coordinator IvanOrlovic, at [email protected] or byphone at (800) 223-0016, ext. 105.

Ivan comes to us from Delta Dentalof Pennsylvania, where he has workedin several insurance-related depart-ments over the span of five years.His knowledge of the dental industry

will help serve members with insur-ance-related problems. Please contacthim for his assistance in handling anyissue you may have with an insurancecompany. Ivan is also available to

attend district and local dental societymeetings to hear from you firsthandand to inform you about PDA’s initia-tives to improve insurance practicesin Pennsylvania.

Insurance Connection

THIRD-PARTY COMPLAINT FORM

1. Date:

2. Dentist Name:

3. County:

4. Third-Party Name:

5. Dentist contracted with plan

6. How was the claim filed, paper or electronic:

7. What type of complaint or problem applies to you?

� Coordination of benefits� EOB language� Downcoding (changed code to a less complex or lower

cost procedure)� Bundling (combining procedures that results in a

reduced benefit)� Review by a non-dentist

8. Utilization review (a system to evaluate procedure utilizationfrequency/plan abuse)� Delayed payment� Denial of claim or pre-authorization� No direct pay to non-participating provider� Denial of payment after pre-authorization� Lost claims, x-rays or other documentation by carrier� Extensive or additional documentation requested� Interference with the doctor-patient relationship� Other

Please give a brief description of the problem and the actual orproposed solution:


Continuing Education


University of PittsburghContact: Lori BurketteAdministrative Secretary(412) 648-8370

On-Campus Programs

October 15OSHA Bloodborne Pathogen UpdateDr. W. H. Milligan

October 16Why Should You be Using anArticulator in Your Practice?Dr. David DonatelliDr. John Ference

October 29The Role of Nutrition in Longevityand the Prevention of DiseasesDr. Nasir Bashirelahi

November 5Potpourri – Topics Include:

Immediate Implant Placement inExtraction SocketsDr. Andrew Baumhammers

Cone Beam Computed Tomographyand Its Applications inDentomaxillolfacial ImagingDr. Anitha Potluri

AttachmentsDr. David Donatelli

Oral Ulcerative DiseasesDr. Joanne Prasad

November 6-7Local Anesthetics for the DentalHygienistDr. Paul Moore

November 12Endodontics Series #1Speaker to be determined

November 13Tylenol and Liver DiseaseDr. James Guggenheimer

November 20Evidence-Based DentistryDr. Robert Weyant

December 3From the HeartDr. James Lichon

December 4Surgical Crown ElongationDr. Pouran FamiliDr. Ali Seyedain

December 10Oral Health Promotion for At-RiskPopulationsDr. Dennis RanalliDr. Deborah Studen-PavlovichDr. Adriana Modesto Vieira

December 11An Update on Local AnesthesiaTherapeutics and ComplicationsDr. Paul Moore

December 11CPRJohn Brewer, NREMT-P

January 15, 2011Public Health Challenges for theDelivery of Dental CareDr. Robert Weyant

January 22, 2011Anesthesia ReviewDr. Paul MooreDr. Joseph GiovannittiDr. Michael Cuddy

February 4, 2011Effective Communication for DentalHygienistsEllen Cohn, PhD, CCC-SLPJoanne M. Nicoll, PhD, RDH

February 5, 2011Conscious Sedation/Med EmergenciesDr. Paul MooreDr. Joseph GiovannittiDr. Michael Cuddy

February 19, 2011Advanced AnesthesiaDr. Paul MooreDr. Joseph GiovannittiDr. Michael Cuddy

March 5, 2011CPRJohn Brewer

March 5, 2011An Update on Local AnesthesiaTherapeutics and ComplicationsPaul A. Moore, DMD, PhD, MPH

March 19, 2011A Review of Radiologic Proceduresfor the Dental Professional:DEP RequirementsJudith E. Gallagher, RDH, MEDMarie D. George, RDH, MS

May 13, 2011Endodontic Continuum:Building Upon SuccessStephen P. Niemczyk, DMD

Off-Campus Programs

Bradford

October 14Pediatric Dentistry Made Easy for theGeneral PractitionerDr. R. Glenn Rosivack

Johnstown

October 13Updates in Pediatric Dentistry:Treating Tiny Tots to TeensDr. Lance Kisby


November 18The Restorative EdgeDr. James Braun

Reading

October 15Miracles and Myths of DirectComposite RestorationsDr. Mark Latta

Temple UniversityContact: Dr. Ronald D. Bushickor Nicole Carreno(215) 707-7541/7006(215) 707-7107 (Fax)Register atwww.temple.edu/dentistry/conted.htm

October 22Update in Restorative DentistryLou Graham, DDS

November 5Exquisite Complete and ImplantRetained Over-Dentures Calibratedfor the General PractitionerJoseph Massad, DDS

November 19Empowering the Dental Team toDeliver “Quality” Periodontal Care inRestorative PracticeSamuel B. Low, DDS, MS, Med

December 3The Art and Science of CAMBRA:A team approach using chemicaltreatments and minimally invasivedentistryDouglas Young, DDS, MS, MBA

WellsboroPennsylvania College of TechnologyContact: Rebecca Von Nieda, PDA(800) 223-0016, ext. 117

October 29It’s About Time!...Early Oral CancerDetectionJonathan Bregman, DDS

DanvilleGeisinger Medical CenterContact: Rebecca Von Nieda, PDA(800) 223-0016, ext. 117

October 27An Overview of Oral Pathology Bobby M. Collins II, DDS, MS

November 17Evidence-Based Dentistry (EBD)in a Clinical Context Richard Niederman, DMD



December 15Hormones, Heart, Health andHygiene: Exploring How Oral HealthAffects Women’s Systemic Well-BeingBetsy Reynolds, MS, RDH

ChambersburgThe Orchards RestaurantContact: Rebecca Von Nieda, PDA(800) 223-0016, ext. 117

October 22Rational and Stress-Free Endodontics Barry Lee Musikant, DMD

November 19Loading of Implants with the Teethin a Day® and Computerized GuidedTeeth in an Hour™ Protocols Glenn J. Wolfinger, DMD, FACP

PDA and PDAISStroudsburgStroudsmoor Country Inn Contact: Rebecca Von Nieda, PDA (800) 223-0016, ext. 117

October 28It’s About Time!...Early Oral CancerDetectionTMJonathan A. Bregman, DDS

MonroevilleDoubletree HotelPittsburgh/MonroevilleConvention Center Contact: Rebecca Von Nieda, PDA(800) 223-0016, ext. 117

November 19Esthetics & Implants—Controversies & Innovations Dennis P. Tarnow, DDS

Dental Society of ChesterCounty and Delaware CountyDKU Continuing Dental EducationSpringfield Country ClubDelaware CountyContact: Dr. Barry Cohen (610) [email protected]

November 11Functional Occlusion in the DailyPractice of DentistryDeWitt C. Wilkerson, DMD

December 10Secrets to Success of High StrengthCeramics in DentistryChristian F.J. Stappert, DDS, PhD

February 2, 2011Christensen’s Bottom Line 2011Gordon Christensen, DDS

April 15, 2011Innovations in Implant DentistryDennis Tarnow, DDS

May 12, 2011Growth and Planning Strategies toImprove Your PracticeMark Murphy, DDS

Schuylkill County DentalSocietyFountain Springs Country Inn(formerly Fountain SpringsCountry Club)Contact: Dr. David Paul(570) 874-1954

October 14Implants for the GeneralPractitioner/Dental Trauma AvulsionDr. Paul Mancia

November 11Orthodontic UpdateDr. John Sadowski

Beaver Valley Dental SocietyContact: Dr. David Spokane (724) 846-9666

December 9Updates on In-Office Anesthesia forthe General DentistDr. Wayne Roccia

January 20, 2011Sedation in the Dental OfficeDr. Walter Laverick

February 17, 20113D Cone Beam Imaging for theDental PracticeDr. Farrel Gerber

March 4, 2011CPR TrainingVangard Medical

Florida Health SeminarDecember 20, 2010 – January 2, 2011Boca Raton, Florida

• Pain Management/Dental AnesthesiaRisk Management

• Endodontics• Implant Dentistry• Pediatric Dentistry

AGD, ADA-CERP CE credits. Specialhotel/car rental rates.

Contact Linda Golnick, coordinator,at (248) 388-1959, (248) 681-0315(FAX) or [email protected].



OPPORTUNITIES AVAILABLE

DentistConsulting firm seeking PracticeTransition Consultant. Full trainingand support. Unlimited earningpotential. [email protected]

or (866) 898-1867.

Outstanding Career OpportunitiesIn Pennsylvania, providing ongoingprofessional development, financialadvancement and more. Positions alsoavailable in FL, GA, IN, MI, VA andMD. For more information contactJeff Dreels at (941) 955-3150, fax CVto (941) 330-1731 or e-mail [email protected]. Visit ourwebsite: www.Dentalcarealliance.com.

Lancaster Group PracticeAssociateship or Associate toPartnership in Lancaster. Large groupdental practice. Income potential of

$100,000 to $200,000 plus. Must bea multi-skilled, excellent dentist. Thismay be one of the best dental prac-tices in the state! Call (717) 394-9231or e-mail [email protected].

POSITION AVAILABLEHarrisburg applicant must be proficientin all chairside phases of fabricatingdentures. This position is ideal fora retired dentist wishing to work parttime. Salary negotiable. Respond toPDA Box S/O 1.

Associate NeededDo you aspire to be a partner in agrowing group practice? Do you havemanagement abilities? Then you maybe the kind of associate we are seeking.Our group is located in the CentralSusquehanna Valley near Bucknelland Susquehanna Universities. We areseeking a general dentist capable ofa wide range of procedures. No HMO’s

Medical Assistance is optional. Wantto know more? Call (570) 742-9607,e-mail [email protected], or fax yourresume to (570) 742-9638.

Associate DentistDental Dreams desires a motivated,quality oriented Associate Dentist forits offices in Pennsylvania (Reading,Harrisburg, York, Allentown andPhiladelphia), Connecticut,Massachusetts, Illinois and Texas. AtDental Dreams, we focus on providingthe entire family superior qualitygeneral dentistry, in a moderntechnologically advanced setting withexperienced support staff. Becausewe understand the tremendous valueof our Associate Dentists, we makesure that their compensation packageranks among the best in the industry.Our average colleague Dentist earns$240,000 per annum, and is supportedwith health insurance, 3 weeksvacation and malpractice insurance.Visa sponsorship assistance is available.For more information, please callChyrisse Patterson at (312) 274-0308,extension 320 or e-mail your CV [email protected].

LONG-TERM CAREEROPPORTUNITYThriving 5-doctor group practice inChambersburg seeks to add an out-standing associate dentist to our group.Beautiful new office facility andwonderful staff. Excellent compensa-tion and benefits. Fee-for-servicepractice, no HMOs. See our websiteat www.chambersburgdentistry.com.Contact Dr. Pastor at PASTOR7@com-

cast.net or (717) 264-2011.

ClassifiedAdvertisements

Rates: $45 for 45 words or less, $1 for each additional word. $1 for each word set in boldface(other than first four words). $10 to box an ad. $5 for PDA Box number reply. One free ad todeceased member’s spouse.

Website: All Journal classified ads will be posted on the public section of the PDA website, unlessotherwise requested. Ads will be posted within 48 hours of receipt, but no earlier than onemonth prior to the date of the Journal issue. Ads will be removed at the end of the two monthsof the Journal issue.

Deadlines: Jan/Feb Issue — Deadline: Nov 1 • Mar/Apr Issue — Deadline: Jan 1 • May/Jun Issue— Deadline: Mar 1 • Jul/Aug Issue — Deadline: May 1 • Sept/Oct Issue — Deadline: Jul 1 •Nov/Dec Issue — Deadline: Sept 1

Payment: Upon submitting ad.

Mailing Address: Send ad copy and box responses to:PDA Dental Journal • PO Box 3341 • Harrisburg, PA 17105

Classified Advertising Policy: The Pennsylvania Dental Association is unable to investigate theoffers made in Classifieds and, therefore, does not assume any responsibility concerning them. TheAssociation reserves the right to decline to accept or withdraw advertisements in the Classifieds.The Journal reserves the right to edit classified ad copy.

How to reply to a PDA Box Number:

Your Name& Address Here

Pennsylvania Dental JournalPO Box 3341Harrisburg, PA 17105

Attn: Box S/O____



Classified Advertisements


General Dentist WantedHealthDrive is seeking a caring GeneralDentist to join our group practice.We currently have a PT (2 days)opportunity available in theScranton/Wilkes-Barre area. We offera competitive salary, paid malpracticeinsurance, flexible schedule (noweekends), established patient base,equipment, supplies and completeoffice support. If interested in thisopportunity, please call MARIA(toll free) at (877) 724-4410 or [email protected].

Dentist WantedPart time. What unique skills can youbring to our practice? Fax resume to(215) 396-9517 or e-mail resume [email protected].

Allentown/Lehigh Valley AreaGENERAL DENTIST needed. Grouppractice is seeking a general dentistfor full-time or part-time employment.Salary commensurate with experience.Associate position available with part-nership potential. Beautiful Allentownarea location with general dentistsand specialists under one roof.Fax resume and cover letter to (610)820-9922 or call (610) 820-9900.

General Dentist WantedGeneral dentist is needed for busy NEPhiladelphia dental office. F/T P/T.Great reimbursement for the rightperson. Call (215) 331-7585 or faxresume (215) 331-7589.

Dentist WantedPediatric dentist, orthodontist isneeded for NE Philadelphia dentaloffice. P/T. Call (215) 331-7585 or faxresume (215) 331-7589.

Dentists WantedGrowing practices located in Newark,Delaware seeking full- and part-timeassociate dentists. Excellent earningpotential in state of the art practices.Fax resume to (302) 369-9777 or

e-mail [email protected] Board Certified preferred butwill consider all applicants. For moreinformation, please visit our website atwww.christianadentalspa.com.

Dentist JobsAspen Dental offers tremendousearning potential and a practicesupport model that empowers you toachieve your goals. We eliminateobstacles for dentists to own theirown practice. To learn more and apply,contact: Seth Cowen, (866) 451-8817,or www.aspendentaljobs.com.

SEEKING GENERALDENTIST/SOUTH CENTRALPENNSYLVANIAExceptional opportunity to own athriving and highly regarded generalpractice. Associateship leading tofull ownership or outright purchasewith option to retain present owneror not. Full FFS with no HMO orPPO. Grossing approximately1.6M with high net. Strong emphasison implant restorations. First class,eight operatory facility. www.cham-bersburgdentalarts.com or contactDr. Jeff Landon (717) 267-0800.

General Dentist WantedSuccessful general dental practice inthe Lancaster area, seeking a full- orpart-time associate for our expandingpractice. Modern workingenvironment, excellent location andoutstanding staff. Interested applicantsmail resume to 22 Millersville Road,Lancaster, PA 17603 or fax to(717) 394-3157.

Dentist WantedDentist wanted at Bradford CountyDental Health Services in Towanda.Towanda is nestled in scenic north-eastern PA, approximately 40 minutessouth of Elmira, NY and 1 hour northof Williamsport, home of the LittleLeague Baseball World Series. Theincumbent shall serve as a general

dental practitioner and utilize theirtechnical skills and professionaljudgment to provide a full range ofdental services to an underservedpopulation.

Many will be eligible for a comprehen-sive benefits package including:•Competitive Pay.• Student Loan Repayment Program,PA State and/or National HealthRecruitment Program Cumulative.

• Annual leave and sick leave.• Retirement benefits, health benefits.• Full- or part-time hours availableMonday through Friday.

We are an Equal EmploymentOpportunity Employer. Contact Robinby e-mail at [email protected].

FOR RENT

Dental Office for RentFive operatories, supply room, handi-cap bathroom, reception area, waitingroom, ramp into the office, 13 park-ing spaces. One block from Rt. 206 inVillage of Lawrenceville, NJ. Pleasecall (609) 896-0224 if interested.

AVAILABLE

Dental Office Space AvailableLocated at 500 W. Township LineRoad, Havertown, PA.

• Available Mondays, Tuesdayafternoons, Thursday and Friday.

•Newly renovated in 2006. • 3 operatories with PCs, Monitorsand Digital X-ray.

• 1 Laboratory.• Business area.• Reception area.•Drs. private office.

Busy corner property at TownshipLine Road and Greenview Lane.Please contact Thomas Chermol Jr.,DDS at (610) 283-3903 or [email protected].

EQUIPMENT FOR SALE

ITEMS FOR SALETwo items for sale: 1) “Ritter “J” chair,delivery unit, light and two stools –in very good condition. 2) Antiquemahogany dental cabinet, multi-drawer,milk glass top, marble base. If inter-ested, please contact (610) 459-3519.

FOR SALE

FOR SALESmall town dental practice and realestate in Lancaster County. First floorwith three operatories. Employeeparking in rear. Second floor privateone bedroom apartment. Averagecollections over $265,000 on twoday/week. Priced to sell. Call (717)665-1587 or [email protected].

Northeast PennsylvaniaWell-established general practice forsale in Wayne County/PoconoMountain area. Owner looking toretire. Completely renovated 1,300 sq.ft. modern office with room forexpansion. Real estate also available.Please contact [email protected] or(570) 862-4921.

Lancaster CountyEstablished family practice for sale inLancaster County. Dentist willing totransition with buy-out. Spaciousoffice with seven ops. and high techequipment. Pleasant suburbansetting. $800,000 gross/yr. Please call(717) 725-0032.

Practice for Sale – Chester CountyExceptional solo general practice.Well-established in growing area. 5ops + 1 plumbed, 2,750 s/f and 2,320active patients. Rev. 700K on 32 hr/wk.Schick digital Panorex, intra-oralcameras, award winning Downingtownschools. (R/E also available) Call (610)269-9099 or [email protected].

North of PittsburghIMMEDIATE SALE: Active generalpractice a few miles north ofPittsburgh. Well established, busy,EXCELLENT staff, facility, patientbase, equipment, OPPORTUNITY.Contact [email protected].

Wilkes-Barre/Hazelton AreaIMMEDIATE SALE: Active generalpractice in the Wilkes-Barre/Hazeltonarea. Well established, busy, two-officepractice. EXCELLENT gross and netrevenues. OUTSTANDING OPPOR-TUNITY. Contact [email protected].

Practice SalesPlease call Nancy Schoyer at(888) 237-4237 or e-mail [email protected] and ask aboutour 19 listings in PA. We havepractices for sale near Harrisburg,four in York County, the Pittsburghand Philadelphia areas, Linesville,Williamsport, Berks County andHanover. Call The MCNOR GROUPAT (888) 273-1014, ext. 103 ore-mail [email protected].

NEW PRACTICES FOR SALEWe have six excellent new listings! Central – Grosses $400K.Great location. 6 ops. FFS.Near Pittsburgh – Practice andbuilding for less than $295K.Motivated seller.Scranton – Practice and buildingavailable. This practice grosses $600K.Berks County – Great place toraise a family. This practice collectsover $900K.Near Chambersburg and Bedford –Practice and building for sale.Great practice.Near Philly – Seeking an associateto buy-in and buy-out. $1.4 millionin revenue in this modern highlyprofitable practice just 30 minutesfrom Philadelphia.

Please see John McDonnell’s article inthe November 2009 issue of the DentalEconomics magazine, page 94 titled“Why Not Sell Now?” Contact THEMCNOR GROUP AT (888) 273-1014ex. 103 or [email protected]

for more information on these andother opportunities in the area.www.mcnorgroup.com.

PRACTICE BUYERS WANTEDFor great practices in the Pennsylvaniaarea. We have many practices avail-able for sale. Are you tired of being anemployee in a dead end job? Call usfor a FREE CONSULTATION to findout about these opportunities. THEMCNOR GROUP, (888) 273-1014,ext. 103 or [email protected].

PRACTICE FOR SALE NEARPITTSBURGHThis is a great opportunity. This prac-tice is located in 1,400+ square feetand has four fully equipped treatmentrooms, and is collecting over $990Kwith high earnings. The real estate isalso available for purchase. This is agreat practice for someone that has adead end job and wants to controltheir destiny. We have 100 percentbank financing available at reasonablerates and terms. THE MCNORGROUP, (888) 273-1014, ext. 103 [email protected].

ERIEEstablished general practice. Sold aspractice only enhancing your practiceand profit margin OR as a turnkeyoperation, including equipment andreal estate. Respond to PDA Box S/O 2.




ORAL SURGERY —PRACTICE FOR SALEWest Virginia, near major university.Great place to live. College sports,educational and cultural activities.Stable economy, growing population.Annual collections $558,000 onreduced schedule. ContactGeorge D. Stollings and Associates,Inc. at (304) 486-5714 [email protected].

Lancaster CountyVery established practice for sale.Newly redecorated, equipment isapproximately 3+ years old. Dentrixsoftware - limited insurances. ContactSharon Mascetti at Henry ScheinProfessional Practice Transitions at(484) 788-4071 or (800) 730-8883.

PRACTICE OPPORTUNITY —NEAR ERIEGeneral Dentistry. Owner seeksassociate that would then purchase thepractice within 2 to 3 years.No Medicaid. No PPOs. Laser,digital X-ray, computer charting,intraoral, camera and more. ContactGeorge D, Stollings and Associates,Inc. at (304) 486-5714 [email protected].

Western Pennsylvania / GreaterPittsburgh Area / Eastern PASeveral practices available withcollections ranging from $200,000to $ 1,000,000.PA (#’s are collections)Shadyside $700,000North Huntingdon $500,000Allison Park $350,000Mercer County $660,000Clearfield County $1,000,000North Huntingdon $550,000Clearfield County $500,000South Westmoreland

County/Greensburg area $210,000

South Hills PediatricPractice $500,000

Mid Mon Valley $250,000Canonsburg $385,000Tri-State Periodontist $750,000Mid Mon Valley $350,000Latrobe $400,000Forest Hills $320,000Venango County $360,000Delaware County $260,000Altoona $280,000OH – Numerous. We also have several other dentalpractices and dental labs available inMichigan, Massachusetts andSouthern California. Please contact Bob Septak at(724) 869-0533, ext. 102 or [email protected] or WWW.UDBA.BIZ.

YorkBusy dental practice in York forimmediate sale. Owner semi-retiringand relocating. Will stay on20 hours max a week to assimilatenew owner. Five operatories withthree hygienists. Please respond [email protected].

Practice for Sale – Pennsauken, NJGeneral dental practice and buildingfor sale, accumulate EQUITY, whileyou work, not rent receipts,Pennsauken, N. J., 7 minutes fromPHILADELPHIA, well knownlocation, 4+ ops, equipment good,1,000+ sq. ft., tax saving investment.Call (856) 665-6404.

Practice for Sale – BurlingtonCounty, NJGeneral/family 4 + 1 ops, 2,000active pts, 1,900 s/f partnership,leased space. Rev. $800K. Call Donnaat (800) 988-5464.

Practice for Sale – Salem County, NJ.W/E, general with 3 ops, free standingbldg., newly renovated, great net! Rev.$600K. Call Donna at (800) 988-5674.www.snydergroup.net.

Dental Practice for Sale –Northwest PAGeneral practice, wonderful community5 ops w/room for expansion. Rev.$541K. Call Donna at (800) 988-5674.www.snydergroup.net.

Practice w/ Real Estate for Sale!South Central PA. General - family,4 ops, freestanding building.Rev $650K. 2,000 active pts. ContactDonna at (800) 988-5674.www.snydergroup.net.

Dental Practice Sale – Adams County6 ops in 2,900 s/f stand alone bldg.R/E for sale, 2,200 active pts. StrongHyg., Digital, Cerec, Intra-OralCameras and Panorex. Rev. $620K.Contact Donna at (800) 988-5674.www.snydergroup.net.

Practice for Sale – Delaware CountyPerfect Area! 2,700 s/f generalpractice. 7 ops, building for sale also.Panorex, Imaging system. Rev. $964K.Contact Donna at (800) 988-5674.www.snydergroup.net.

Dental Practice Sale – CumberlandCounty4 ops in 2,200 S/F (r/e also available)free standing building. Over 3,000active pts. 4 days/wk. Strong hyg.Rev. $527K 6 yr. young practice.Contact Donna at (800) 988-5674.www.snydergroup.net.

Camden County, NJ – Home Officefor SaleBeautiful corner property, office –1,300 s/f. home – 2,400 s/f, 4 large ops.– 2,000 active pts. All endo referred.Rev. $324K. Contact Donna at(800) 988-5674. www.snydergroup.net.

PRACTICE FOR SALEDUTCHESS County, NY. Wonderful,4 ops, digital, general practice with2,000 active patients. Rev $825K.Contact Donna at (800) 988-5674.www.snydergroup.net.



Dental Practice Sale – NorthamptonCountyGeneral, freestanding buildingw/1,600 s/f, 4 new Adec ops + add’lops., 2,000 active pts. Rev. $1.2M.Contact Donna at (800) 968-5674.www.snydergroup.net.

Wayne CountyGeneral practice with great reputation.Consistently collects over $800,000per year on 4 days per week. 1,500active patients, 5 treatment suites (3equipped, 2 plumbed, ready for equip-ment). Very warm, comfortable facility.High profit margin with purchaserincome of $315,000 after debt service.Contact [email protected].

Berks/Schuylkill County AreaMore than 2,000 active patients, 40new patients per month and growing.Five treatment rooms and very modernand bright office. Collections in excessof $900,000 with excellent cashflow.Contact [email protected].

Chester CountyGroup practice opportunity. Excellentcommunity reputation. Group hasmore than 9,000 active patients andprovides mix of general dentistry. Veryattractive cashflow and compensationrate. Contact [email protected].

Harrisburg West ShoreA tremendous opportunity to purchasea small practice with 1,250 activepatients and turn it into a very highproducing practice. Great cash flow,tax benefits and return on investment.Excellent facility and equipment.All the right ingredients for success.Real estate available also. [email protected].

North Central Pennsylvania2,100 active patients, 6 fullyequipped treatment rooms, collectionsof $400,000. Two busy full-timehygienists. Excellent growth potentialand tremendous value. College town.Contact [email protected].

Delaware CountyGreat Opportunity! ACB of 600patients collecting 180,000 a month,3 plumbed ops with 2 equipped withimpressive new equipment andcustom cabinets. Growing practice iscomputerized and digital. Greatmerger or start up practice. [email protected].

HarrisburgBusy, long standing city practice withhigh traffic location and visibility.2,800 active patients and tremendouspotential to boost revenues. Excellentcash flow and return on investment.Real estate also available. [email protected].

Central Dauphin CountyHershey area (15 minute drive),great location, all phases of dentistry.1,200 active patients, mostly FFS.Great pre-tax cash flow and taxbenefits. Real estate available. [email protected].

Halifax$500,000 part-time. 1, 600 s/f, 4 ops(2 dentists, 2 hygienists). Growthpotential, low overhead. Staff stays.Area underserved. 25 miles northof Harrisburg; great for outdoorsman.Office tour: Dolphin-dps.com.(512) 864-1628.

North Central PennsylvaniaDental practice and office buildingfor sale in scenic North CentralPennsylvania. Owner looking toretire. Please respond to PDA BoxS/O 3.

Practice and Office Building for SaleFor sale in Western Pennsylvania, adental practice and income producingoffice building, which includes fouroperatories. The practice/office build-ing is located in a beautiful collegecommunity. 100% financing available.Call (724) 458-7620.

PROFESSIONAL SERVICES

Practice TransitionsSelling – buying – merging –establishing associateships.CERTIFIED VALUATIONS FOR ALLPURPOSES by Master CertifiedBusiness Appraiser. ProfessionalPractice Planners, 332 Fifth Avenue,McKeesport, PA 15132.(412) 673-3144 or (412) 621-2882(after hours.)

Consulting ServicesCPA having 23+ years’ experience(including with AFTCO Associates)offers independent dental advisoryservices involving Buying, Selling,Mediation, Valuation, Expert Witnessor Tax Planning. Joseph C. Bowers,MBA, CPA/PFS, (610) 544-4100 ore-mail [email protected].

PARTNERSHIPS OR DELAYEDSALESWe have many satisfied clients withassociates in your area that we havehelped to either buy-in, buy-outor a delayed sale with the currentassociate. Without a quality valuationand plan up-front, these transactionsnormally fail. Call or e-mail us toarrange a FREE CONSULTATION tofind out if you are a candidate forthis service. The result is higherincome and a higher practice valuefor the seller and a clear financiallypositive path for the associate. THEMCNOR GROUP, (888) 273-1014,ext. 103 or [email protected].

www.mcnorgroup.com.




NEW OWNER REPRESENTATIONOur family and organization hasrepresented over 1,000 new ownersover the last 65 years in theMid-Atlantic area that have purchased,started or became partners in a dentalpractice. Ownership is a decisionthat is too important to make withouta qualified facilitator. We can get thenew owner 100 percent financingplus working capital. Call us for aFREE CONSULTATION and allow usto send you a list of our references.THE MCNOR GROUP, (888) 273-1014,ext. 103, or [email protected].

www.mcnorgroup.com.

PRACTICE VALUATIONAPPRAISALWe are the only transition consultingcompany in the area that has aCertified Valuation Analyst (CVA) as aprincipal that focuses exclusively on

the transition of DENTAL PRACTICES.Please see the article by CVA KarenNorris on page 82 of the April ‘07issue of Dental Economics on thissubject or call or email us for a FREECONSULTATION and a copy of thearticle. If you are selling, buying,creating a partnership or just want tofind out the current value of yourpractice contact THE MCNORGROUP, (888) 273-1014, ext. 103,or [email protected].

www.mcnorgroup.com.

Practice TransitionsWe specialize in Practice Sales,Appraisals and PartnershipArrangements in Eastern Pennsylvania.Free Seller and Buyer Guides avail-able. For more details on our services,contact Philip Cooper, DMD, MBAAmerica Practice Consultants, (800)400-8550 or [email protected].



Professional Temporary CoverageProfessional temporary coverageof your dental practice (locumtenens) during maternity, disabilityand personal leaves. Free, noobligation quotes. Absolute confi-dentiality. Trusted integrity, since1996. Nation’s most distinguishedteam. Always seeking new dentiststo join the team. No cost, stringsor obligation - ever! Work onlywhen you wish (800) 600-0963.www.doctorsperdiem.com. E-mail:[email protected].